scholarly journals Necrotizing Fasciitis Case Series: Improved Outcomes with Early Diagnosis and Effective Surgical Interventions in Low Resource Settings

2018 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Early Diagnosis ◽  
Necrotizing Fasciitis ◽  
Fluid Resuscitation ◽  
Broad Spectrum ◽  
Community Hospital ◽  
Case Series ◽  
Surgical Debridement ◽  
Necrotising Fasciitis ◽  
Surgical Interventions ◽  
Improved Outcomes

Necrotizing fasciitis (NF) is a severe, rare, potentially lethal and fulminant soft tissue infection. It is marked by necrosis of the superficial fascia, neutrophil infiltration of the deep dermis and fascia, thrombosis of the cutaneous microcirculation, and the presence of the infecting organism in the necrotic tissue. The infection progresses rapidly with systemic signs of toxicity and septic shock may ensue; hence, the mortality rate is high (median mortality 32.2%). Prognosis becomes poorer in the presence of co-morbidities, such as diabetes mellitus, immunosuppression, chronic alcohol disease, and in poor resource settings. Early and aggressive meticulous surgical debridement constitutes the mainstay of treatment along with broad spectrum antibiotics and fluid resuscitation. Postoperative management of the surgical wound is also important for the patient’s survival, along with proper nutrition. Objective: To determine improved outcomes with early diagnosis and cost effective surgical interventions for patients necrotizing fasciitis at Bwindi community hospital,Uganda. Design: These are case series of 6 patients who presented with fulminant necrotising fasciitis admitted to the hospital through the emergency wing. Materials and methods: Six patients presented with fulminant nectrozing fasciitis admitted at Bwindi community Hospital between August 2015 and June 2017, were analysed, and appropriate effective surgical management based on these patients is suggested. Results: These patients were all admitted after a minimum of 3.8 days from the on onset of the infection. The average timing of debridement through fish fillet incisions was 14 and 4 hours from the time of admission and diagnosis respectively. The average number of redebreidments were six. There was 83.3% survival after treatment, with 16.6% mortality. Vacuum dressings were used for one paediatric case. 50% of the wounds healed by secondary intention, 16.6% by secondary closure and 16.6% done full thickness skin grafting. Placement of the testicles in subcutaneous pockets in the thigh was done for one patient. In 100% were of the patients dressing with honey gauze was used for the alternate day bed side dressing. Conclusion: The diagnosis of necrotising fasciitis is a challenge, however early meticulous surgical debridement, supported by fluid resuscitation and broad spectrum antibiotic clinical administration is key to survival of these patients.

Synergistic necrotizing cellulitis resulting from peri-tonsillar abscess

1996 ◽  
Vol 110 (9) ◽  
pp. 887-890 ◽  
Author(s):  
P. J. Hadfield ◽  
M. Motamed ◽  
G. W. Glover
Keyword(s):  
Necrotizing Fasciitis ◽  
Head And Neck ◽  
Broad Spectrum ◽  
Early Recognition ◽  
Surgical Debridement ◽  
Successful Outcome ◽  
Prompt Treatment ◽  
Intravenous Antibiotics

This case demonstrates the rare but potentially fatal condition of synergistic necrotizing cellulitis of the head and neck. Although similar to necrotizing fasciitis, this is more extreme as it also destroys muscle. Peri-tonsillar abscess is a recognized cause, but has not previously been described in this country, however it is a condition commonly referred to otolaryngologists and awareness of the complication of synergistic necrotizing cellulitis is necessary to allow early recognition and prompt treatment. This should be by broad-spectrum intravenous antibiotics with extensive surgical debridement and drainage procedures repeated as necessary. Although this case had a successful outcome, many patients do not survive, particularly if treatment is delayed or inadequate.

scholarly journals Necrotizing Fasciitis in Neonate and Use of Allograft

2019 ◽  
Vol 8 (1) ◽  
pp. 8
Author(s):  
Nitinkumar Borkar ◽  
Phalguni Padhi ◽  
Jiten Kumar Mishra ◽  
Shamendra Anand Sahu ◽  
Debajyoti Mohanty ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Necrotizing Fasciitis ◽  
Skin Graft ◽  
Subcutaneous Tissue ◽  
Donor Site ◽  
Subcutaneous Fat ◽  
Surgical Debridement ◽  
Split Thickness Skin Graft ◽  
Superficial Fascia ◽  
Thickness Skin

Necrotising fasciitis is a fulminant and rapidly progressive infection of the superficial fascia and subcutaneous tissue. It is rare in newborn. Trunk is the commonest site of involvement in newborns. Early diagnosis and prompt surgical debridement is the preferred treatment. Debridement in NF leads to a large raw area which may not heal by primary intention and may a split thickness skin graft for healing. Presence of minimum subcutaneous fat, loose skin and large raw area at donor site like back in some neonate poses difficulty for harvesting of skin graft. In such neonates allograft make a valuable option temporarily. Herein we report a case of a neonate with NF in whom post debridement raw area was covered with allograft from mother.

Necrotizing Fasciitis: Myalgia Is Diagnostic? A Case Series and Literature Review

2020 ◽  
pp. 153473462095860
Author(s):  
Sachin Teelucksingh ◽  
Vijai Deonarine ◽  
Shariful Islam ◽  
Shamir O’Cawich ◽  
Dave Harnanan ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Early Diagnosis ◽  
Necrotizing Fasciitis ◽  
Subcutaneous Tissue ◽  
Case Series ◽  
Muscular Activity ◽  
Clinical Suspicion ◽  
Prompt Treatment ◽  
Diagnostic Difficulties ◽  
Radiologic Features

Necrotizing fasciitis, commonly known as “flesh-eating disease,” is an aggressive soft tissue infection that destroys the fascia, subcutaneous tissue, and skin. Specific clinical features (crepitus or radiologic features of gas in tissues) either appear late or are of poor sensitivity. Thus, a high index of clinical suspicion is required for early diagnosis and prompt treatment, which are the best methods of minimizing its high associated morbidity and mortality. We present 3 cases to demonstrate diagnostic difficulties and challenges in management and highlight the feature of pain on muscular activity.

scholarly journals Varicella gangrenosum in adult: a fatal chickenpox complication

2019 ◽  
Vol 12 (4) ◽  
pp. e226363
Author(s):  
Ashish Sharma ◽  
Samarth Agarwal ◽  
Anamika Sharma ◽  
Manoj Kumar
Keyword(s):  
Early Diagnosis ◽  
Bacterial Infection ◽  
Antibiotic Treatment ◽  
Disseminated Intravascular Coagulation ◽  
Soft Tissues ◽  
The Body ◽  
Surgical Debridement ◽  
Necrotising Fasciitis ◽  
Systemic Complications ◽  
Intravascular Coagulation

Varicella gangrenosum is a gangrenous ulceration of varicella lesions involving the skin and soft tissues of the body. The term was coined more than 100 years ago. This occurs due to superimposed bacterial infection. The presentation of primary varicella in adults is more severe with catastrophic systemic complications as compared with children. These complications include necrotising fasciitis, disseminated intravascular coagulation, wet/dry gangrene and death, as was seen in our case. Survival is dependent on early diagnosis and treatment. Adequate antibiotic treatment and particularly early radical surgical debridement should be the cornerstone of management. Less than 10 such cases are reported in the literature.

Surgical debridement and adjunctive hyperbaric oxygen in cervical necrotizing fasciitis

2009 ◽  
Vol 140 (5) ◽  
pp. 730-734 ◽  
Author(s):  
Carrie E. Flanagan ◽  
Opeyemi O. Daramola ◽  
Robert H. Maisel ◽  
Cher Adkinson ◽  
Rick M. Odland
Keyword(s):  
Necrotizing Fasciitis ◽  
Hyperbaric Oxygen ◽  
Case Series ◽  
Surgical Debridement ◽  
Diabetic Patients ◽  
Intravenous Antibiotics ◽  
Computed Tomography Scans ◽  
Aggressive Medical Management ◽  
Length Of Hospitalization ◽  
Combined Data

Objective: To review our management of cervical necrotizing fasciitis (CNF) with the use of adjunctive hyperbaric oxygen therapy (HBO). Study Design: Case series with chart review. Subjects and Methods: Evaluation of ten patients with CNF between 2001 to 2006. Results: There were five male and six female patients. Mean age was 43 ± 11 years. Eight cases resulted from an odontogenic source. Comorbidities included diabetes mellitus, hypertension, and substance abuse. All patients had computed tomography scans performed, received intravenous antibiotics, and underwent surgical debridement. Eight patients underwent surgery within 24 hours. The average number of debridements was 2.2 ± 0.8. Hospitalization was twice as long for diabetic patients (15.5 ± 8.16 days) compared with nondiabetic patients (7.5 ± 1.6 days, P = 0.029). Nine patients had HBO therapy. Combined data revealed a possible decrease in length of hospitalization with HBO therapy ( P < 0.001). No mortality was documented. Conclusion: In addition to early and aggressive medical management and surgical debridement, this study suggests that HBO therapy is a beneficial adjunct by potentially decreasing length of hospitalization. Randomized trials are still needed to demonstrate its efficacy.

Postoperative Necrotizing Fasciitis in Children

PEDIATRICS ◽  
1988 ◽  
Vol 82 (6) ◽  
pp. 874-879
Author(s):  
Leo D. Farrell ◽  
Stephen R. Karl ◽  
Paul K. Davis ◽  
Mark F. Bellinger ◽  
Thomas V. N. Ballantine
Keyword(s):  
Necrotizing Fasciitis ◽  
Surgical Procedures ◽  
Broad Spectrum ◽  
Subcutaneous Tissue ◽  
Failure To Thrive ◽  
Skin Grafting ◽  
Antibiotic Use ◽  
Surgical Debridement ◽  
Superficial Fascia ◽  
Clean Contaminated

Necrotizing fasciitis is a rapidly progressive soft tissue infection, involving the skin, subcutaneous tissue, and superficial fascia. It is a rare but life-threatening complication in the postoperative patient. In the last 7 years, we have treated four children in whom necrotizing fasciitis developed after appendectomy for ruptured appendix, bilateral inguinal herniorrhaphy, or gastrostomy closure. These four patients and seven well-described children from the literature with necrotizing fasciitis following surgery form the basis of this review. The ages ranged from six days to 15 years (ean 4.5 years). There were eight boys and three girls. There were five clean, five clean-contaminated, and one contaminated surgical procedures. No patient had evidence of malignancy or diabetes. Two of our four patients had evidence of failure to thrive. Only one patient had an intraabdominal abscess. In ten, the infection started in the abdominal wall; in one, the infection started in the chest wall. In our four patients, three had neutropenia and fever, four had tachycardia, and two had wound crepitation and radiographic evidence of subcutaneous gas. Cultures of all ten wounds were positive for bacteria; six were positive for more than one organism. Blood culture results were positive in five of five patients who died and in only two of five patients who survived. All survivors had wide surgical debridement and were treated with broad-spectrum antibiotics. The mortality rate was 45% in the whole series. In our four patients, the only death occurred in a child with Down syndrome and failure to thrive whose parents refused further therapy. Necrotizing fasciitis may complicate clean surgical procedures in children without risk factors. Septicemia is a late and ominous sign. Early wide surgical debridement and broad-spectrum antibiotic use are necessary for survival. Skin grafting is often required for late coverage of these defects.

scholarly journals Management of Necrotizing Fasciitis with Proximal Tibia Fracture

2021 ◽  
Vol 11 (5) ◽  
Author(s):  
Shubhankar Patil ◽  
Dilip Kumar ◽  
Karthik Rao ◽  
Navratan Dipu
Keyword(s):  
Necrotizing Fasciitis ◽  
High Mortality ◽  
Broad Spectrum ◽  
Proximal Tibia ◽  
Road Traffic ◽  
Group A Streptococcus ◽  
Tibia Fracture ◽  
Surgical Debridement ◽  
Proximal Tibia Fracture ◽  
Broad Spectrum Antibiotics

Introduction: Necrotizing fasciitis is a rare disease of soft tissue infection with a high mortality. It is characterized by rapidly spreading inflammation and necrosis of fascial planes. It usually follows an injury, though the cause may be a small abrasion or an insect bite or surgical incisions. It is commonly caused by bacteria such as Group A streptococcus. It may be accompanied by septic shock. It causes rapid death unless it is diagnosed quickly and managed aggressively. Prompt surgical debridement must be done to reduce mortality. Rapid diagnosis, antibiotic therapy, fluid resuscitation, and surgical debridement of the infection are all needed in the management of this fatal disease. However, when necrotizing fasciitis is associated with an underlying fracture the treatment becomes even challenging and limb-threatening. Case Report: A 48-year-male patient of South Asian descent came to Emergency Room with history of road traffic accident and sustained injury to the right (RT) leg. He was admitted with pain, swelling and blisters of the RT leg and suspected to have necrotizing fasciitis with proximal tibia fracture of the RT leg. He was treated with thorough surgical debridement, broad-spectrum antibiotics, free flap, and Masquelet’s technique with limb reconstruction system (LRS). At 18 months of follow-up the fracture healed, LRS was removed, pin tracts healed and patient was able to walk without any support. Conclusion: Necrotizing fasciitis is rare, rapidly progressive disease with a high mortality rate which requires prompt diagnosis, early surgical debridement, broad-spectrum antibiotics, careful fluid, and electrolyte management. These patients require a combined multidisciplinary approach for their management. Keywords: Necrotizing fasciitis, proximal tibia fracture, surgical debridement.

scholarly journals “The Clock Is Ticking”: The Timely Management of a Painful Skin Rash in a Seventy-Year-Old Woman

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Susan Thomas ◽  
Folashade Omole ◽  
Vijaykumar G. Patel ◽  
Michelle L. Nichols
Keyword(s):  
Septic Shock ◽  
Necrotizing Fasciitis ◽  
Skin Rash ◽  
Broad Spectrum ◽  
The Body ◽  
Surgical Debridement ◽  
Erythematous Rash ◽  
Intravenous Antibiotics

Necrotizing fasciitis is an uncommon but a potentially fatal condition and can affect any part of the body. Most patients have pre-existing conditions that render them susceptible to infection, although etiology is unclear. Diagnosis is primarily clinical and is often delayed because of the unfamiliarity of the condition among clinicians. Management consists of immediate resuscitation, early surgical debridement, and administration of broad spectrum intravenous antibiotics. We report a case of a 70 year old woman who presented with a painful erythematous rash, was admitted as a case of cellulitis, later developed worsening of symptoms and septic shock, and was diagnosed as necrotizing fasciitis.

scholarly journals Cervical Necrotizing Fasciitis of Odontogenic Origin in a Diabetic Patient Complicated by Substance Abuse

2014 ◽  
Vol 25 (1) ◽  
pp. 69-72 ◽  
Author(s):  
Rubens Camino Junior ◽  
Maria G. Naclerio-Homem ◽  
Lecy Marcondes Cabral ◽  
João Gualberto C. Luz
Keyword(s):  
Substance Abuse ◽  
Antibiotic Therapy ◽  
Diabetic Patient ◽  
Necrotizing Fasciitis ◽  
Broad Spectrum ◽  
Surgical Debridement ◽  
Response To Treatment ◽  
Rapid Progression ◽  
Broad Spectrum Antibiotic ◽  
Odontogenic Origin

Cervical necrotizing fasciitis (CNF) is an uncommon, potentially fatal soft tissue infection with rapid progression characterized by necrosis in the subcutaneous tissue and fascia. A case of CNF of odontogenic origin in a diabetic patient, complicated by alcohol dependence and tobacco abuse, is presented with a literature review. The emergency procedure comprised hydration, colloid administration, glycemic control and broad spectrum antibiotic therapy, followed by aggressive surgical debridement. Necrosis in the platysma muscle was verified by histopathologic analysis. Reconstructive surgery was performed after suppressing the infection, and the wound was closed with an autologous skin graft. The patient had a long hospital stay, in part because the substance abuse led to a difficult recovery. The principles of early diagnosis, aggressive surgical debridement, broad-spectrum antibiotic therapy and intensive supportive care in the treatment of CNF were confirmed in the present case. It was concluded that given the occurrence of CNF in the presence of diabetes mellitus and abuse of substances such as alcohol and tobacco, the health care professional should consider a stronger response to treatment and longer hospitalization.

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