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PubMed1996

[Necrotizing fasciitis].

Necrotizing soft tissue infection or necrotizing fasciitis is a rapidly progressive inflammation that leads to necrosis of subcutaneous tissues and fascia with secondary necrosis of skin. It is usually attributed to group AB hemolytic streptococci but may be caused by anaerobic bacteria. It occurs with higher frequency in elders, diabetics, alcoholics and patients with impaired immunity. Report mortality rates range from 14 to 80%. An early and timely surgical debridement with remotion of all necrotic tissue is mandatory. Wounds must be closed with splint skin grafts as soon as the local viability of tissues has been assured and the general conditions of the patients allow the procedure. Antibiotics nutritional and hemodynamic support are also necessary.

Fasciitis, Necrotizing↗
PubMed2002

[Deep necrotizing soft tissue infections. Necrotizing fasciitis and necrotizing myositis].

The authors present a review on deep soft tissue infections--necrotizing fasciitis and necrotizing myositis, incl. the classification of myositis into sub-groups according to the causal agent. The authors describe the incidence of these diseases, basic clinical symptoms and therapeutic principles. Therapy is based on surgical treatment, antimicrobial treatment and in indicated cases on hyperbaric oxygen therapy (HBO).

Fasciitis, Necrotizing↗
PubMed1986

Necrotizing fasciitis.

Necrotizing fasciitis was diagnosed in 16 patients during the years 1980 to 1984. All patients were managed by a uniform protocol consisting of radical excisional surgery, intravenous antibiotics, and hyperbaric oxygen therapy. An overall mortality rate of 12.5% was achieved. In view of the encouraging results, this therapeutic regimen is highly recommended.

Adult↗
PubMed1994

Early recognition of neonatal abdominal wall necrotizing fasciitis.

Necrotizing fasciitis (NF) of the abdominal wall occurring in newborns is associated with a 50% mortality rate. Improved survival requires early diagnosis followed by aggressive surgical débridement. During a 10-year period, we treated 7 infants who developed NF. During the same period, 32 infants were admitted with omphalitis that did not progress to NF. The patients with omphalitis and those with NF were compared. Tachycardia, abnormal white blood cell counts, induration, and violaceous skin discoloration were seen exclusively in the NF patients. Polymicrobial infections were documented in 28% of the omphalitis patients and 86% of the NF patients. All omphalitis patients survived, whereas 5 of 7 (71%) NF patients died. Adjuvant hyperbaric oxygen therapy was used for 4 infants with NF, 2 of whom survived (50%). NF is a highly morbid disease, that can be distinguished from other infant abdominal wall infections by the skin changes, white blood cell counts, heart rate, and microbiologic results. Prompt diagnosis of NF improves survival when combined with aggressive surgical débridement.

Abdominal Muscles↗
PubMed1981

Blood coagulation and fibrinolytic systems in patients with erysipelas and necrotizing fasciitis.

Necrotizing fasciitis (NF) is a skin infection caused by a group A streptococci, resulting in an erythematous lesion with cyanosis and vesicles or bullae leading to gangrene. The condition is prostrating and often accompanied with cerebral confusion. A table of diagnostic scores is given to differentiate initial symptoms and signs of NF from erysipelas (E). Assays of blood coagulation and fibrinolysis together with routine laboratory examinations were made in 12 patients with NF on admission to the hospital and they were compared with similar analyses of 5 patients with E. The NF and E patients showed increased levels of fibrinogen, factor V and factor VIII as well as positive ethanol gelation test, which hypercoagulability as did also decrease antithrombin III and increased levels of fibrinopeptide A. Slightly increased levels of fibrinogen degradation products were also noted. The Hageman factor was low in E compared to NF. In both conditions fibrin formation seems to be enhanced, most probably more extensively in NF. General signs of secondary fibrinolysis were less conspicuous. It is possible that the Hageman factor is activated to modulate the inflammatory response differently in E than in NE.

Aged↗
PubMed1987

Improved results from a standardized approach in treating patients with necrotizing fasciitis.

Necrotizing fasciitis has been associated with significant morbidity and mortality. Thirty-three patients were studied over a 3-year period. Predisposing factors included intravenous drug abuse (30%), diabetes (21%), and obesity (18%). Severe pain (94%) and abnormal temperature (88%) were present, whereas laboratory data and x-ray were nonspecific. Gram-positive organisms were most frequently recovered (B-hemolytic streptococcus 45%). Treatment consisted of antibiotics, surgical debridement, re-exploration 24 hours before surgery, nutritional support, and early soft tissue coverage as needed. Mean duration from admission to operation was 43 hours. The average number of operative debridements was three and the average length of hospitalization was 47 days. Patients operated on less than 12 hours from admission or greater than 48 hours had shorter hospital stays (36 and 38 days). The critical time period was 12-48 hours after admission; all deaths and amputations were in this group and the average hospital stay was 62 days (p less than 0.05). The number of operations did not correlate to hospital stay. Despite antibiotics and aggressive debridement, significant morbidity exists if operation is delayed more than 12 hours. Methods of early detection such as local bedside diagnostic incision and fascial inspection may be needed in high risk patients to further reduce the morbidity and mortality.

Adult↗
PubMed1981

Necrotizing fasciitis.

Necrotizing fasciitis is a lethal and insidious disease with a high mortality. It often begins in areas exposed to fecal or urinary contamination, and about 70% of cases occur in diabetics. A high index of suspicion should be maintained in diabetic patients with an infection in the perineum, genitalia, thigh, or buttocks. Factors leading to a poor prognosis are increased age and extent of disease at the time of diagnosis, especially myonecrosis. Therapy is primarily radical surgical debridement with adjunctive antibiotic therapy.

Adult↗
PubMed1987

Periorbital necrotizing fasciitis.

Necrotizing fasciitis developed in a 47-year-old woman after head trauma. Bilateral lid infection due to Group A beta-hemolytic streptococci resulted. Local treatment with surgical debridement and systemic management of fluid and electrolyte balance resulted in a favorable outcome from this extremely rare condition.

Eyelid Diseases↗
PubMed1984

Necrotizing fasciitis.

Necrotizing fasciitis is a synergistic infection caused by aerobic and anaerobic organisms, resulting in liquefaction and necrosis of the fascia. Clinical findings typically include septicemia, anemia and radiographic evidence of gas in the soft tissue. Most patients have a history of diabetes or atherosclerosis. Morbidity and mortality can be reduced by early diagnosis, extensive surgical debridement and aggressive nutritional support.

Bacterial Infections↗
PubMed1983

The importance of early diagnosis and surgical treatment of necrotizing fasciitis.

Necrotizing fasciitis is a severe infection with a mixed bacterial population involving a single tissue plane. It is best diagnosed by the history of minor trauma, extreme toxicity, anesthesia of the skin and roentgenologic evidence of soft tissue gas. Initial treatment consists of antibiotics, intravenously administered fluids, blood transfusions, calcium and general patient support. Surgical procedures include extensive debridement as soon as possible and as needed for continued necrosis, secondary closure and skin grafting. The mortality of this disease has not been altered by antimicrobials. Only early recognition and surgical treatment will improve the prognosis.

Adolescent↗
PubMed2001

[Subacute forms of necrotizing fasciitis and necrotizing cellulitis: diagnosis criteria and surgical decision-making].

Subacute cellulitis could be described as intermediary forms between benign erysipelas and life-threatening necrotizing fasciitis with toxic shock syndrome. The key point is to consider any cellulitis a possible indication for surgery. Subacute cellulitis may occur in the elderly or diabetic patients. Local signs (cyanosis, necrosis.) are sometimes isolated. They may occur during the evolution of cellulitis requiring a medical treatment. This emphasizes the importance of carefully following-up any patient treated by antibiotics for cellulitis, i.e. monitoring the extension of erythema (using a felt-pen) and atypical local signs. Complementary investigations are especially helpful when diagnosing cellulitis requiring a surgical treatment: fine-needle aspirations; histology; soft-tissue X-ray; MR imaging that can detect alterations of the cutis and fascia, myositis, and abscesses. Surgery can be delayed for such patients, allowing for a better preparation. Sometimes, only surgical exploration may confirm cellulitis. Lastly, some cases may mimic surgical cellulitis but a prolonged course of antibiotics is able to control the disease. Abscesses requiring secondary surgical evacuation may complicate all these insidious features.

Cellulitis↗
PubMed1985

Necrotizing fasciitis.

Necrotizing infections of soft tissues are rapidly progressive infections accompanied by a high mortality. Clinical presentation involves fever, cellulitis, edema, crepitus, bullae, necrosis and sepsis. Operative findings include fascial and subcutaneous tissue necrosis with or without myonecrosis. The treatment is prompt surgical debridement. Delay in treatment results in decreased survival time. The mortality in our study was 30 per cent (20 of 33). The time from recognition of an infection by the patient or physician until operative debridement averaged three and one-half days for survivors compared with 11.7 days for nonsurvivors. These infections frequently occur in compromised hosts and the mortality is greatly increased in these patients. Patients with diabetes had a mortality of 63 per cent (five of eight). The mortality for infections of the abdomen (44 per cent) and perineum (38 per cent) is greater than for the extremities (18 per cent). The bacteriologic findings of these infections involved three combinations of organisms. We had 30 mixed infections involving two or more organisms. In addition, three patients had identical signs and symptoms caused by infection with a single organism--Vibrio species. These patients all had some type of contact with a marine environment as a predisposing cause. We also applied both the APACHE and SIS systems to these patients to evaluate the severity of the illness. Nonsurvivors presented with a mean SIS score of 8.64 compared with survivors with 3.82. Initial scores with the APACHE system for nonsurvivors was 12.0 compared with 2.14 for survivors. In both systems, scores rapidly increased at three and seven days in nonsurvivors as compared with a rapid decline in the survivors. We suggest that the best descriptive system is to simply identify the organisms and tissues involved.

Adult↗
PubMed2004

Conventional open surgery versus percutaneous catheter drainage in the treatment of cervical necrotizing fasciitis and descending necrotizing mediastinitis.

OBJECTIVE: The purpose of our study was to determine the clinical usefulness of percutaneous catheter drainage compared with conventional surgical drainage for cervical necrotizing fasciitis and descending necrotizing mediastinitis. SUBJECTS AND METHODS. Thirty-one patients with cervical necrotizing fasciitis and descending necrotizing mediastinitis were included. Twenty consecutive patients were treated by percutaneous catheter drainage. Catheters were introduced into the infected space from the neck, under the guidance of sonography and X-ray fluoroscopy. The results of the treatment were compared with those of 11 patients treated previously by surgical drainage. RESULTS: In the catheter group, no patient required supplementary surgical drainage. Mortality was 0% in both groups. Comparison of length of stay in the ICU, serial changes in C-reactive protein levels, duration of antibiotic therapy, and duration of mechanical ventilation all showed no statistically significant difference between groups. Secondary infection of the wound and positive culture of antibiotic-resistant bacteria were observed less frequently in the catheter group than in the open surgical group. The total use of plasma infusion and analgesics was significantly less in the catheter group than in the surgery group. Oral feeding was started significantly earlier in the catheter group than in the surgery group. CONCLUSION: Percutaneous catheter drainage for cervical necrotizing fasciitis and descending necrotizing mediastinitis was less invasive than conventional surgical drainage but produced a similar outcome.

Adolescent↗
PubMedDate not supplied

[Necrotizing fasciitis of the head and neck. Report of 4 cases of cervical necrotizing fasciitis].

Necrotizing fasciitis is a severe polybacteria infection characterised by necrosis of the fascial and adjacent soft tissues with rapid expansion of the infection along fascial planes. It may originate potentially fatal complications and often is accompanied by systemic toxicity. It is not a frequent entity in the head and neck, but early diagnosis is very important because early treatment based on intravenous antibiotherapy and aggressive surgical debridement can prevent complications that often cause the death of the patient. Pour reports of necrotizing fasciitis are presented, one of them with fatal outcome, which leads us to emphasize the importance of an early diagnosis.

Aged↗
PubMed2004

The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections.

OBJECTIVE: Early operative debridement is a major determinant of outcome in necrotizing fasciitis. However, early recognition is difficult clinically. We aimed to develop a novel diagnostic scoring system for distinguishing necrotizing fasciitis from other soft tissue infections based on laboratory tests routinely performed for the evaluation of severe soft tissue infections: the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score. DESIGN: Retrospective observational study of patients divided into a developmental cohort (n = 314) and validation cohort (n = 140) SETTING: Two teaching tertiary care hospitals. PATIENTS: One hundred forty-five patients with necrotizing fasciitis and 309 patients with severe cellulitis or abscesses admitted to the participating hospitals. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The developmental cohort consisted of 89 consecutive patients admitted for necrotizing fasciitis. Control patients (n = 225) were randomly selected from patients admitted with severe cellulitis or abscesses during the same period. Hematologic and biochemical results done on admission were converted into categorical variables for analysis. Univariate and multivariate logistic regression was used to select significant predictors. Total white cell count, hemoglobin, sodium, glucose, serum creatinine, and C-reactive protein were selected. The LRINEC score was constructed by converting into integer the regression coefficients of independently predictive factors in the multiple logistic regression model for diagnosing necrotizing fasciitis. The cutoff value for the LRINEC score was 6 points with a positive predictive value of 92.0% and negative predictive value of 96.0%. Model performance was very good (Hosmer-Lemeshow statistic, p =.910); area under the receiver operating characteristic curve was 0.980 and 0.976 in the developmental and validation cohorts, respectively. CONCLUSIONS: The LRINEC score is a robust score capable of detecting even clinically early cases of necrotizing fasciitis. The variables used are routinely measured to assess severe soft tissue infections. Patients with a LRINEC score of > or = 6 should be carefully evaluated for the presence of necrotizing fasciitis.

Abscess↗
PubMed2005

Correlation of histopathologic findings with clinical outcome in necrotizing fasciitis.

BACKGROUND: Necrotizing fasciitis is an uncommon disease with high morbidity and mortality rates. Little is known about the role of histopathologic examination in disease prognosis. METHODS: A retrospective study was conducted to determine what correlations, if any, exist between the histopathologic features of resected tissue in patients with necrotizing fasciitis and clinical outcome. RESULTS: Eighty-two cases of necrotizing fasciitis that occurred between January 1990 and December 2002 were identified. Histopathologic findings were available for review in 63 cases. A novel histopathologic classification scheme, based on hematoxylin-eosin and Gram stain results, was developed. The classification scheme included 3 stages: stage I, characterized by an intense neutrophilic response and an absence of bacteria in infected tissue; stage II, characterized by the presence of a moderate-to-severe neutrophilic response and positive Gram stain results or by minimal to absent neutrophilic response with a negative Gram stain result; and stage III, characterized by the presence of few or no polymorphonuclear leukocytes and a Gram stain result positive for bacteria during histopathologic examination. Patients with stage I findings had a significantly lower risk of death than patients with stage III findings (7.1% vs. 47%; odds ratio [OR], 0.1; 95% confidence interval [CI], 0.01-0.8; P=.03). Patients with stage II findings had a significantly lower mortality rate than patients with stage III findings (14.2% vs. 47%; OR, 0.2; 95% CI, 0.04-0.9; P=.04). Due to the small number of deaths (n=11) in patients for whom histopathologic examination of resected tissue was performed, multivariate analysis was not done. CONCLUSIONS: Results of this study suggest that histopathologic findings may correlate with clinical outcome in cases of necrotizing fasciitis. Because the histopathologic scheme is based on results of commonly available stains, it could be easily adopted for use in other institutions that could further evaluate its usefulness as a prognostic tool.

Adolescent↗
PubMed2003

Anesthetic implications of cervicofacial necrotizing fasciitis.

Cervicofacial necrotizing fasciitis is a necrotizing soft tissue infection of face and neck spreading at the level of fascia. It has been described as a putrid ulcer, phagedaena, and hospital gangrene. It has a high mortality rate, and presents a challenge to anesthesiologists who must secure an airway to deliver anesthesia safely. We report a case of cervicofacial necrotizing fasciitis in which the patient underwent repeated radical surgical debridement of face and neck, including a mandibulectomy. These critically ill patients often present with sepsis and multiple system organ failure. Extensive preoperative evaluation, invasive monitoring, and possibly the use of vasopressors and inotropes are essential in treating these patients. The tracheas of these patients should remain intubated after initial debridement. Tracheostomy should be performed early. Antibiotic therapy, nutritional support, early debridement, and hyperbaric oxygen therapy all help to decrease mortality in these patients.

Anesthesia, Inhalation↗