scholarly journals Necrotizing fasciitis of head – neck

1970 ◽  
Vol 14 (1) ◽  
pp. 9-14
Author(s):  
Sudhangshu Shekhar Biswas ◽  
Zaheer Al-Amin
Keyword(s):  
Antibiotic Therapy ◽  
Necrotizing Fasciitis ◽  
Primary Source ◽  
Good Control ◽  
Surgical Debridement ◽  
Electrolyte Imbalance ◽  
Diabetic Patients ◽  
Source Of Infection ◽  
Life Threatening ◽  
Head Neck

Necrotizing Fasciitis of head -neck is not so uncommon in diabetic patients which is a progressive, destructive and potentially life threatening soft tissue infection primarily affecting superficial fascial planes. It is caused by group A streptococci or by a synergistic combination of aerobe and anaerobe micro organisms. This is a retrospective study which makes an attempt to analyze various parameters such as demography, aetiology, complications, and management methods determining the overall prognosis. Odontogenic infection was the primary source of infection. Diabetes, anaemia, chronic renal failure and electrolyte imbalance were the most commonly associated illness. Surgical debridement with combined antibiotic therapy was used in the management of necrotizing fasciitis along with good control of diabetes and correction of anaemia and electrolyte imbalances. Overall mortality was low. The late referral and associated complications had increased the hospital stay. With proper control of infection by early diagnosis, surgical debridement and combined antibiotic therapy, along with timely control of complications and associated illness - better results can be possible. Key words: necrotizing fasciitis, antibiotics, debridement  DOI: 10.3329/bjo.v14i1.3274 Bangladesh J of Otorhinolaryngology 2008; 14(1) : 9-14

Cervicofacial necrotizing fasciitis: can we expect a favourable outcome?

2004 ◽  
Vol 118 (10) ◽  
pp. 771-777 ◽  
Author(s):  
Naresh K. Panda ◽  
Sridhar ◽  
Suryanarayana Rao Sridhara
Keyword(s):  
Antibiotic Therapy ◽  
Necrotizing Fasciitis ◽  
Head And Neck ◽  
Primary Source ◽  
Favourable Outcome ◽  
Surgical Debridement ◽  
Source Of Infection ◽  
Total Hospital Stay ◽  
Gram Negative Organisms ◽  
Aerobic And Anaerobic

Necrotizing fasciitis of the head and neck is an uncommon, progressive, destructive soft tissue infection of mixed aerobic and anaerobic organisms, having high mortality if left untreated (22 to 100 per cent). This study makes an attempt to analyse various factors and management methods determining the overall prognosis.A retrospective analysis of all cases of necrotizing fasciitis involving the head and neck, with exclusion of those involving the eyelid and the scalp, was undertaken. Various parameters such as demography, aetiology, complications, management and outcome were studied.Males outnumbered the females with the latter having a greater risk of involvement after 60 years. Odontogenic infection was the primary source of infection. Anaerobes were cultured in seven out of 17 cases, with six others showing mixed Gram positive and Gram negative organisms. Anaemia was the most commonly associated illness, with diabetes affecting four out of 17 cases.Aggressive surgical debridement with triple antibiotic therapy was used in the management of necrotizing fasciitis with an overall mortality of 11.8 per cent. Patients having late referral, anaemia and one or other complication had increased duration of total hospital stay.Better results can be obtained with proper control of infection by early diagnosis, aggressive surgical debridement and triple antibiotic therapy, along with timely control of complications and associated illnesses.

Necrotizing Fasciitis with No Mortality or Limb Loss

2008 ◽  
Vol 74 (9) ◽  
pp. 809-812 ◽  
Author(s):  
Deborah A. Martin ◽  
Gabriella N. Nanci ◽  
Steven I. Marlowe ◽  
Alan N. Larsen
Keyword(s):  
Mortality Rate ◽  
Antibiotic Therapy ◽  
Necrotizing Fasciitis ◽  
Surgical Debridement ◽  
Limb Loss ◽  
Closure System ◽  
Vacuum Assisted Closure ◽  
Topical Negative Pressure ◽  
Aggressive Surgical Approach

Necrotizing fasciitis is a potentially lethal invasive soft tissue infection. Early aggressive antibiotic therapy and surgical debridement have been the hallmark of successful therapy. It is commonly held that delays in surgical debridement significantly increase the mortality rate and rate of limb loss. A mortality rate of 20 per cent or greater has been reported throughout the last 80 years. We recently reviewed the cases of 20 consecutive patients admitted to our hospital in various stages of necrotizing fasciitis progression. Treatment of all 20 patients consisted of antibiotic therapy and surgical debridement, with frequent follow-up serial debridement. Topical negative pressure was achieved with the use of the Vacuum Assisted Closure system. An aggressive surgical approach, (including the frequency of debridement, appropriate antibiotic utilization, and use of the Vacuum Assisted Closure system), significantly impacted our results, despite delays in treatment and progression of the infection.

scholarly journals Diagnosis and management of necrotizing fasciitis in the light of the recent recommendations

2019 ◽  
Vol 41 part 1 (2) ◽  
pp. 77-84
Author(s):  
C. O. Kosulnikov ◽  
V. N. Lisnichaya ◽  
A. M. Besedin ◽  
S. І. Karpenko ◽  
S. A. Tarnopolsky ◽  
...  
Keyword(s):  
Necrotizing Fasciitis ◽  
Soft Tissues ◽  
Subcutaneous Fat ◽  
Surgical Debridement ◽  
Type I ◽  
Cause Of Deaths ◽  
Life Threatening ◽  
Management Modality ◽  
Closure Method ◽  
Primary Management

Summary: Necrotizing fasciitis is a rare but life-threatening infection of the soft tissues. It is characterized by spreading inflammation and necrosis starting from the fascia, muscles, and subcutaneous fat, with subsequent necrosis of the overlying skin. Necrotizing fasciitis is classified into four types, depending on microbiological findings. The diagnosis of this disease is difficult. Late diagnosis is observed in 85–100% of cases and is considered the only cause of deaths. Emergency surgical debridement is the primary management modality for necrotizing fasciitis. Vacuum assisted closure therapy is fast and effective wound closure method. Antibiotics and surgical debridement play a key role in the treatment of necrotizing fasciitis.In our hospital, there were 75 patients with necrotizing fasciitis in the last 5 years (type I – 92%, type II – 8%). We observed localization of necrotizing fasciitis in the perineum (32%), upper extremities and chest (25%), lower extremities (28%), abdominal wall and retroperitoneal space (15%). Mortality was 9,5%. Keywords: necrotizing fasciitis, sepsis, surgical debridement.

Necrotizing fasciitis: A life-threatening clinical disorder in uncontrolled type 2 diabetic patients

2008 ◽  
Vol 80 (2) ◽  
pp. 218-223 ◽  
Author(s):  
O. Oncul ◽  
C. Erenoglu ◽  
C. Top ◽  
Y. Küçükardalı ◽  
O. Karabudak ◽  
...  
Keyword(s):  
Necrotizing Fasciitis ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Clinical Disorder ◽  
Life Threatening ◽  
Type 2 Diabetic

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.

Vibrio vulnificus-Induced Necrotizing Fasciitis Complicated by Multidrug-Resistant Acinetobacter baumannii Infection: Efficacy of Chemical Necrectomy Using 40% Benzoic Acid

2021 ◽  
pp. 153473462110043
Author(s):  
Bretislav Lipový ◽  
Radomir Mager ◽  
Filip Raška ◽  
Marketa Hanslianová ◽  
Josef Blažek ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Benzoic Acid ◽  
Necrotizing Fasciitis ◽  
Acinetobacter Baumannii ◽  
Soft Tissue Infection ◽  
Vibrio Vulnificus ◽  
Tissue Infection ◽  
Diabetic Patients ◽  
High Morbidity ◽  
Life Threatening

Necrotizing fasciitis is a life-threatening skin and soft tissue infection associated with high morbidity and mortality in adult patients. This infection can present as either type 1 infection caused by a mixed microflora ( Streptococci, Enterobacteriacae, Bacteroides sp., and Peptostreptococcus sp.), most commonly developing in patients after surgery or in diabetic patients, or as type 2. The latter type is monomicrobial and, usually, caused by group A Streptococci. Rarely, this type can be also caused by other pathogens, such as Vibrio vulnificus. V vulnificus is a small mobile Gram-negative rod capable of causing 3 types of infections in humans—gastroenteritis, primary infection of the vascular bed, and wound infections. If infecting a wound, V vulnificus can cause a life-threatening condition—necrotizing fasciitis. We present a rare case of necrotizing fasciitis developing after an insect bite followed by exposure to the seawater. Rapid propagation of the infectious complication in the region of the right lower limb led to a serious consideration of the necessity of amputation. Due to the clearly demarcated necroses and secondary skin and soft tissue infection caused by a multiresistant strain of Acinetobacter baumannii, we, however, resorted to the use of selective chemical necrectomy using 40% benzoic acid—a unique application in this kind of condition. The chemical necrectomy was successful, relatively gentle and thanks to its selectivity, vital parts of the limb remained preserved and could have been subsequently salvaged at minimum blood loss. Moreover, the antimicrobial effect of benzoic acid led to rapid decolonization of the necrosis and wound bed preparation, which allowed us to perform defect closure using split-thickness skin grafts. The patient subsequently healed without further complications and returned to normal life.

scholarly journals 1351 Primary Pituitary Abscess Presenting as An Isolated Bitemporal Hemianopia

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
E Tan ◽  
A Zammit
Keyword(s):  
Primary Source ◽  
Pituitary Surgery ◽  
Resonance Imaging ◽  
Pituitary Abscess ◽  
Cystic Fluid ◽  
Source Of Infection ◽  
Life Threatening ◽  
Pituitary Lesion ◽  
Bitemporal Hemianopia ◽  
Transsphenoidal Resection

Abstract Pituitary abscesses are rare yet life-threatening entities. Most common presenting features are headache, hypopituitarism, and visual changes. Majority of patients are found to have a predisposing risk factor, such as a pre-existing pituitary lesion, recent pituitary surgery or irradiation, or a primary source of infection. We present the case of a 53-year-old male with a spontaneous pituitary abscess, who presented with an isolated bitemporal hemianopia, but was otherwise asymptomatic with no known risk factors. Magnetic resonance imaging showed a sellar and suprasellar mass, thought to be a pituitary macroadenoma. He underwent endoscopic transsphenoidal adenectomy and cystic fluid was seen intraoperatively. Microbiology analysis showed Staphylococcus Aureus, and a course of intravenous ceftriaxone was commenced. Histopathology reported no evidence of adenoma and impression was of a pituitary abscess. Following transsphenoidal resection and commencement of antibiotic therapy, the bitemporal hemianopia resolved. We therefore report a rare case of primary pituitary abscess and emphasise the importance of including this condition as a differential diagnosis in any patient with a visual deficit or new pituitary lesion.

scholarly journals Non Clostridial Gas Gangrene Leading to Stroke in Postoperative Period- A Case Report

2021 ◽  
Author(s):  
Sukhvir Singh ◽  
Gazala Shabeen
Keyword(s):  
Postoperative Period ◽  
Soft Tissues ◽  
Intensive Therapy ◽  
Gas Gangrene ◽  
Diabetic Patients ◽  
Source Of Infection ◽  
Life Threatening ◽  
Systemic Manifestations ◽  
Prompt Diagnosis ◽  
Very High

Gas gangrene is a life threatening infection of muscles and soft tissues which is associated with very high mortality rate. Non clostridial gas gangrene is a rare phenomenon that mostly occurs in diabetic patients. Gas gangrene leads to various systemic manifestations. A 66-year-old female patient, diabetic with chronic kidney disease, on haemodialysis was presented as a rare case of non clostridial right great toe gas gangrene, which progressed to systemic toxicity and stroke within a period of 72 hours in postoperative period. The source of infection in this case may have been Acinetobacter which is a gram-negative bacterium. Despite prompt diagnosis and intensive therapy, the patient died 15 days after the operation. After going through literature, no case was found to be reported of stroke in postoperative period due to non clostridial gas gangrene thus making it a unique case to report. Also, only few cases of life threatening non clostridial gas gangrene are reported in literature.

scholarly journals Parvimonas micra: A potential causative pathogen to consider when diagnosing odontogenic brain abscesses

2020 ◽  
Vol 11 ◽  
pp. 140
Author(s):  
Ruth Prieto ◽  
Alejandro Callejas-Díaz ◽  
Rasha Hassan ◽  
Alberto Pérez de Vargas ◽  
Luis Fernando López-Pájaro
Keyword(s):  
Antibiotic Therapy ◽  
Brain Abscess ◽  
Primary Source ◽  
16S Rrna Gene Sequencing ◽  
Rrna Gene ◽  
Sequencing Analysis ◽  
Surgical Drainage ◽  
Source Of Infection ◽  
Parvimonas Micra ◽  
Brain Abscesses

Background: Brain abscess is a life-threatening entity which requires prompt and long-term antibiotic therapy, generally associated with surgical drainage, and eradicating the primary source of infection. Parvimonas micra (Pm) has only been reported once before as the lone infecting organism of an orally originated, solitary brain abscess. Diagnosing brain abscesses caused by this Gram-positive anaerobic coccus, constituent of the oral cavity flora, is challenging, and an optimal treatment regimen has not been well established. We report the diagnosis and successful treatment of a Pm caused odontogenic brain abscess. Case Description: A 62-year-old immunocompetent male with a right-parietal brain abscess presented with headache and seizures. He was started on empirical antibiotic therapy and subsequently underwent surgical drainage. The only source of infection found was severe periodontitis with infected mandibular cysts. Thus, tooth extraction and cyst curettage were performed 1 week after brain surgery. Cultures of brain abscess fluid were negative, but amplification of bacterial 16S ribosomal RNA (rRNA) with polymerase chain reaction demonstrated Pm. After 3 weeks of intravenous ceftriaxone and metronidazole, the patient was switched to oral metronidazole and moxifloxacin for 6 weeks. Conclusions: This case highlights the potential risk of untreated dental infections causing brain abscesses. Pm should be considered as a possible pathogen of odontogenic brain abscesses despite its presence usually not being detected by standard bacterial cultures. Therefore, 16S rRNA gene sequencing analysis is strongly recommended for bacterial identification before defining brain abscesses as cryptogenic.

scholarly journals Massive necrotizing fasciitis following bellow-knee arterial surgery: A therapeutic challenge

2015 ◽  
Vol 72 (5) ◽  
pp. 469-472
Author(s):  
Petar Popov ◽  
Slobodan Tanaskovic ◽  
Vuk Sotirovic ◽  
Dragoslav Nenezic ◽  
Djordje Radak
Keyword(s):  
Necrotizing Fasciitis ◽  
Wide Spectrum ◽  
Clinical Signs ◽  
Systemic Infection ◽  
Surgical Debridement ◽  
Bypass Grafting ◽  
Superficial Fascia ◽  
Wound Swab ◽  
Life Threatening ◽  
Skin Reconstruction

Introduction. Necrotizing fasciitis is a rare, progressive bacterial infection of superficial fascia followed by secondary subcutaneous tissue necrosis. We pressented a patient with massive fulminant lifethreatening necrotising fasciitis after bellow-knee femoro-popliteal vein bypass grafting successfully treated by antibiotics, surgical debridement and final skin reconstruction using the Tierch method. Case report. A 61-year-old patient was ad-mitted to the Vascular Surgery Clinic for below-knee femoro-popliteal bypass grafting. He complained of intermittent claudication in the left leg after 50 m, ankle brachial indexes were 0.45 on the left and 1.0 on the right side. Femoropopliteal below-knee bypass grafting was done using the autologous great saphenous vein. In the very next day, initial signs of skin infection appeared including local inflammation, erythema, swelling and cellulitis restricted to saphenectomy site. These changes had rapidly spread in the following days on the deep tissue of the whole upper and lower leg, including the groin and with clinical signs of life-threatening systemic infection. Immediate surgical debridement was done followed by extensive wound packing and wide spectrum antibiotics administration for the next 33 days when final skin reconstruction by the Tierch method was performed. Interesting point is that this entire time wound swab was sterile. Conclusion. In the presented case immediate surgical debridement, wide spectrum antibiotics administration and consistent wound packing gave satisfactory results in this life-threatening systemic infection. Wound swab is not always a reliable indicator of the infection while clinical findings and surgeons? experience are of great significance in rapid reaction to this rare surgical complication.

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