Silver Nanoparticles Can Relieve Progressive Necrosis by Regulating Macrophage Activation in Burn Wounds

Purpose: To investigat the positive influence of AgNP on preventing early burn-wound progression.Patients and methods: After a deep burn, progression of burns may occur in the initial or surrounding area，even after thermal factors have been removed. Due to the influence of many factors such as residual heat, the risk of burn stagnant area deterioration is very high which is considered to be salvable. Silver nanoparticles (AgNP), which has been wide used in burns, is a strong antibacterial agent that has been reported to regulate inflammation. Hence, to investigat the positive influence of AgNP on avoid early burn wound progressive deterioration, a isomorphic “comb” burn animal model was made in this study which were treated with silver nanoparticles. The wound tissues were taken for molecular biological and histological evaluation, which revealed that AgNP alleviated histological deterioration in burn stagnant area. Results: Furthermore, AgNP can alleviate the early progressive necrosis and inflammatory response of burn wound, which was accociated with excitation in M2 macrophage and a suppression of M1 macrophage.Conclusion: In conclusion, we demonstrate that AgNP has a protective effect on acute burn wound deterioration in a rat model. It might be regulated by the macrophage activation-induced inflammation and apoptosis.

Fournier’s Gangrene of the Shoulder Girdle

Fournier’s gangrene is uncommon, a high-mortality infection that affects the subcutaneous tissue with rapidly progressive necrosis. Reports on cases involving the shoulder girdle are more rare. Similar to the presentation on other regions of the human body, fundamental is early diagnosis and surgical intervention.

Cholecystocutaneous Fistula Associated with Necrotizing Fasciitis of the Abdominal Wall: A Case Report

Cholecystocutaneous fistula represents an extremely rare complication of calculous cholecystopathy. In the past 50 years, less than 50 cases have been reported. The most frequent site of spontaneous cholecystocutaneous fistula is the right hypochondrium, followed by the left hypochondrium, periumbilical, right lumbar, right iliac fossa and gluteal areas. The association with necrotizing fasciitis that represents a serious infection, characterized by extensive and rapidly progressive necrosis, affecting the subcutaneous plane and reaching the muscular fascia provides a high mortality rate and extensive procedures are required. Herein we present a case of a 64-years-old, female, admitted to the emergency department with complaint of diffuse, severe abdominal pain, associated with a tense and painful lesion in the abdominal wall with the diagnose of cholecystocutaneous fistula associated with necrotizing fasciitis that despite an aggressive surgical approach developed a multisystem failure and died 24 hours after admission.

Reperfusion After Severe Frostbite: First Full-Thickness Necrosis After Initial Successful Thrombolysis

A 36-year-old male who suffered severe frostbite injuries to both feet presented with an estimated total body surface area at around 4%. These injuries resulted from the patient travelling from his town by foot, with a temperature of −10°C during 4 days. On route, he received rewarming therapy followed by thrombolysis that was initiated as the duration of the warm ischemia period resided under 24 hours. Immediately after the procedure, the feet recovered clinically up to the distal toes. Saturation revealed normal values. Thrombolysis ceased after 9 hours and angiography showed adequate perfusion of the toes. Three hours later, pedal pulses at the toes were lost. Subsequently, the patient developed blisters and progressive necrosis of the toes to midfoot. Both feet were managed expectantly and were dressed, but the conditions of both feet worsened and the tissue turned into full-thickness necrosis. The decision was made to amputate a month after thrombolysis.

Noncoding RNAs in Steroid-Induced Osteonecrosis of the Femoral Head

Steroid-induced osteonecrosis of the femoral head (ONFH) is a severe orthopedic disease caused by the long-term administration of glucocorticoids. The main pathological feature of ONFH is the gradually progressive necrosis of bone cells and the bone marrow, ultimately resulting in structural changes or even complete collapse of the femoral head. However, the exact pathogenic mechanism of ONFH remains unknown. Noncoding RNAs (ncRNAs) have emerged as very powerful regulators of gene expression, functioning at both transcriptional and posttranscriptional levels in the pathogenesis of ONFH. Here, we review the current knowledge of the role of ncRNAs, including microRNAs, long noncoding RNAs, and circular RNAs, in the pathogenesis of steroid-induced ONFH. Further focus and validation of these associations can provide new insight into the pathogenic mechanisms at the molecular level to suggest targets for treatment and prevention.

Necrotizing soft tissue infection at an uncommon site following tooth extraction

Necrotizing soft tissue infection (NSTI) is a disease characterized by rapidly progressive necrosis involving skin, subcutaneous tissue, fascia or muscle. It is commonly seen in extremities, perineum and lower abdomen. It is extremely uncommon for necrotizing fasciitis to occur along the chest wall, with only a few such cases being reported. We report one such rare case of NSTI in a 75 year old male who underwent left molar tooth extraction developed Ludwig’s angina which progressed to present as a painful swelling over the left side of the neck and chest with a necrotic patch of skin over manubrium sternum managed successfully.

Mucormycosis due to Apophysomyces species complex- 25 years’ experience at a tertiary care hospital in southern India

Apophysomyces elegans species complex is an important cause of cutaneous mucormycosis in India. However, majority of those cases are reported as case reports only. We desired to analyze our patients with Apophysomyces infection reported over 25 years (1992–2017) to understand the epidemiology, management, and outcome of the disease. During the study period 24 cases were reported, and the majority (95.8%) of them presented with necrotizing fasciitis following accidental/surgical/iatrogenic trauma. One patient presented with continuous ambulatory peritoneal dialysis (CAPD) related peritonitis. Healthcare related Apophysomyces infection was noted in 29.2% patients. In addition to trauma, comorbidities were noted in 37.5% patients (type 2diabetes mellitus-6, chronic alcoholism-2, and chronic kidney disease-1). Of the 24 isolates, 11 isolates starting from year 2014 were identified as Apophysomyces variabilis by molecular methods. Majority (95.8%) of the patients were managed surgically with or without amphotericin B deoxycholate therapy, while one patient was treated with amphotericin B deoxycholate alone. Among 24 patients, seven (29.1%) recovered, six (25%) patients could not afford antifungal management and left the hospital against medical advice, and 11 (45.9%) patients died.The present case series highlights that necrotizing fasciitis caused by A. variabilis is prevalent in India, and the disease may be healthcare related. Although diagnosis is not difficult, awareness among surgeons is still limited about the infection, leading to a delay in sending samples to the mycology laboratory. Apophysomyces infection must be considered in the differential diagnosis in apatient with progressive necrosis of a wound who is not responding to antibacterial therapy.

A case of streptococcus necrotizing fasciitis secondary to acute tonsillitis and review of literatures

Necrotizing fasciitis, officially named by Wilson in 1952, was a rare potentially life-threatening necrotizing soft tissue infections disease. The main lesions showed subcutaneous fat and fascia layer in progressive necrosis, generally not involving muscles. It was characterized by acute onset, rapid progress, and dangerous condition, often accompanied by systemic toxin shock, which was a relatively rare clinical acute critical disease with high mortality rate. Necrotizing fasciitis is a rare but clinical critical disease. The overall incidence of necrotizing fasciitis is approximately 0.04 cases per 1000 persons in the United States, the 30-day mortality is 27%, and necrotizing fasciitis–related mortality in Asian region is about 28%. Streptococcus pyogenes (group A streptococcus) are human-specific pathogens that can cause upper respiratory tract infection such as tonsillitis, associated with post-infection diseases such as rheumatic fever, and also can induce severe invasive diseases such as necrotizing fasciitis and streptococcus toxin shock syndrome. This article reports a case of streptococcus necrotizing fasciitis secondary to suppurative tonsillitis, which was seldom reported before and our successful management with delayed debridement. This study was anonymous and was approved by the local Research Ethics Committee. Informed consent was obtained from the patient.

Approach to Reconstruction of Nasal Defects

The nose is the most central and anterior projecting facial feature. Therefore, the presence of a defect is easily noticeable to the untrained eye. Return of the defect to the original form is an achievable end goal of reconstruction, necessitating appropriate reformation of three-dimensional geometry, proper establishment of symmetry, and excellent color and texture match to the adjacent structures. Regarding its physiological importance, disruption of the normal function may cause respiratory obstruction and contribute to patient distress. To achieve successful repair, preoperative preparation must consider the location, the layers involved, and the size of the defect. Prompt and well-organized repair minimizes the occurrence of progressive necrosis and severe late-stage deformity. Here the authors provide a framework to approach various nasal defects and provide a review of the novel ideologies and techniques. The workhorse of nasal repair, the forehead flap, is discussed independently due to the breadth of innovation.

Necrotizing Soft Tissue Infections

Necrotizing soft tissue infections (NSTI) are characterized by extensive and rapidly progressive necrosis that may involve the skin, subcutaneous tissue, fascia, or muscle and are associated with a high degree of morbidity and mortality. Preceding trauma, foreign body penetration, wound contamination, and surgical intervention are all risk factors for NSTI. Clinical examination often reveals extensive tissue involvement with pain but commonly without signs of cellulitis. Crepitant cellulitis occurs most commonly in patients with preexisting lower extremity peripheral arterial disease, decubitus ulcer, or a traumatic wound. Synergistic necrotizing cellulitis (ie, non-clostridial gangrene), in contrast, does involve deeper tissues. Early stabilization, including antibiotics and supportive measures, should be considered; consultation with a surgeon is key. Management must include aggressive resuscitative measures and hemodynamic support.