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PubMed1992

Necrotizing fasciitis of the extremities.

Necrotizing fasciitis is a limb- and life-threatening soft-tissue infection. Eighteen patients with necrotizing fasciitis of the extremities were reviewed. These infections occurred most commonly after minor trauma. Associated chronic debilitating diseases were present in 13 patients. All but two infections were polymicrobial. The overall mortality rate was 33%. Death was caused by persistent wound sepsis in three and systemic septic complications in spite of apparent local infection control in three. At the admission physical examination the condition may resemble a benign, low-grade cellulitis. Three of four patients died because of a delay in surgical debridement for more than 24 hours after admission. Multiple radial debridements of the involved skin, fat, and fascia are essential to control progressive necrosis. Our results suggest that early diagnosis and prompt surgical debridement of necrotizing fasciitis are essential for survival.

Adult↗

PubMed2003

A successfully treated case of severe necrotizing fasciitis caused by acute appendicitis: a case report.

We successfully saved a patient with appendicitis followed by necrotizing fascitis. A 77-year-old man with a history of ambulatory treatment for depression underwent an emergency operation because of severe abdominal pain. Laparotomy demonstrated that necrotizing appendicitis was massively extending over the abdominal cavity, involving the right paracolic sulcus and Douglas pouch and posterior surface of the right kidney. Irrespective of the emergency surgery, redness and swelling in the right chest and abdomen, which was noted at the time of admission, was not decreased. Successively, a retension incision was performed under the diagnosis of necrotizing fasciitis. Necrotizing fasciitis is an extremely rare complication of appendicitis, and there were only 10 cases documented. Once necrotizing fasciitis occurs, the mortality rate is high, so that correct diagnosis and prompt debridement are mandatory. Particularly for elderly patients with appendicitis, rapid and accurate diagnosis and treatment are required.

Acute Disease↗

PubMed2001

[What data is needed today to deal with cellulitis and necrotizing fasciitis?].

Cellulitis and necrotizing fasciitis can be distinguished by the depth of the cutaneous lesion and classically by the different bacteria implicated. This classification is not taken into account by the practitioner because of a similar therapeutic strategy. That is why most authors used a single title: necrotizing soft tissue infection. The potential severity of these infections required a quick diagnosis to decrease the risk of mortality and severe functional consequences. The analysis of the literature doesn't allow to establish the incidence of these infections. It was demonstrated that infections due to Streptococcus serogroup A increased over the last few years, thanks to a specific surveillance system. Risk factors leading to these infections are: cutaneous trauma, age, diabetes, varicella in children, contact with people infected by Streptococcus. The most recent studies demonstrated a frequent polymicrobism of the infections, with anaerobes, Streptococcus, Staphylococcus, and gram-negative rods. At the onset of the disease, the diagnosis is difficult to establish. Pain, induration of tissues, a rapid evolution, the inefficacy of antibiotic treatment suggest the diagnosis of necrotizing infection. MRI, when available, is a good technique to reveal the depth of the infection and necrosis. Surgery will confirm the diagnosis and allow for debridement of necrotized tissues. A delayed surgery increases the mortality risk factor, as stated in numerous studies.

Cellulitis↗

PubMed2007

Necrotizing fasciitis secondary to diverticulitis.

Necrotizing fasciitis is a rare, rapidly progressive infectious process primarily involving the fascia and the subcutaneous tissue, with thrombosis of the cutaneous microcirculation. We present a case of necrotizing fasciitis secondary to diverticulitis in an immunosuppressed patient with rheumatoid arthritis.

Aged↗

PubMed1995

Acute necrotizing fasciitis in childhood.

Acute necrotizing fasciitis is a rare but frequently catastrophic infection of the subcutaneous tissues and fascial sheaths. It is rare in infants and children. The case of a 3 1/2-year-old boy with acute necrotizing fasciitis caused by group A beta hemolytic streptococcus is described.

Amputation, Surgical↗

PubMed1995

Fatal necrotizing fasciitis following a mandibular fracture.

Necrotizing fasciitis of the head and neck is an uncommon, insidious infection that usually occurs secondarily to odontogenic infections, although blunt and penetrating trauma can be another cause. Of 65 total reported cases of necrotizing fasciitis, 10 (15.4%) have been fatal. This article presents a case of a mandibular fracture in a severely immunocompromised elderly patient in whom delayed treatment proved fatal. The clinician must remain suspicious of any infection refractory to antibiotic therapy alone, since necrotizing fasciitis is a rapidly progressing condition with high morbidity and potential for mortality. Rapid diagnosis, surgical treatment, antibiotic therapy, medical management, nutritional support, and early detection and treatment of complications are critical elements in the management of necrotizing fasciitis.

Aged↗

PubMedDate not supplied

Necrotizing fasciitis of the breast.

Necrotizing fasciitis is a potentially fatal condition that can affect any part of the body. It can occur after trauma, around foreign bodies in surgical wounds, or can be idiopathic. We describe a case of necrotizing fasciitis involving the breast following an initial debridement of an inflammatory lesion.

Breast Diseases↗

PubMed2004

[Necrotizing fasciitis of the thigh].

INTRODUCTION: Necrotizing fasciitis is a rare and severe infectious disease with infectious necrosis often extending in depth to the subcutaneous tissue in the absence of rapid medical-surgical treatment. We report two cases of necrotizing fasciitis of the thigh, which underline the principle clinical and therapeutic characteristics of this often underrated disease. OBSERVATION: The first case concerns a young 21 year-old woman without remarkable medical history who, following injury from the thorn of a palm tree, developed an aerobic germ necrotizing fasciitis which regressed following medical-surgical treatment. The second case concerned a 46 year-old man suffering from diabetes and arteritis, who having presented an infection following the amputation of the large toes, developed fatal necrotizing fasciitis. COMMENTS: This disease corresponds to infectious necrosis of the subcutaneous tissue and is essentially characterized by its rapid, occasionally violent, progression. It represents a surgical emergency and requires early and extensive incision in order to avoid severe functional after effects, or even death of the patient. Only enhanced education of the physicians leading to rapid clinical diagnosis will improve the prognosis which still remains fearsome.

Adult↗

PubMed2004

A rare complication of endoscopic sinus surgery: necrotizing fasciitis of the eyelid.

Necrotizing fasciitis is a soft tissue infection characterized by necrosis of fascia and subcutaneous tissue. It frequently involves the groin, abdomen and lower extremities, but rarely involves the head and neck region. An unusual occurrence of periorbital necrotizing fasciitis after a routine endoscopic sinus surgery in a 57-year-old woman with a history of type II diabetes mellitus is presented. Although the disease is very rare, all the physicians should be aware of the manifestations of this disorder and its treatment. Early recognition and prompt intervention plays an important role in minimizing the morbidity and mortality rates.

Diabetes Mellitus, Type 2↗

PubMed1998

Craniofacial necrotizing fasciitis secondary to sinusitis.

Necrotizing fasciitis is a rare condition which usually affects the trunk, perineum and limbs. Head and neck involvement is very uncommon and in most cases it is secondary to orbital or dental infection. We report a case of craniofacial necrotizing fasciitis (CNF) secondary to a maxillary sinusitis. The patient was treated intensively with antibiotics, surgical procedures and life-support measures. Despite all efforts, the patient died one week after admission. This case highlights early diagnosis and aggressive management as decisive factors for the outcome of the patient.

Aged↗

PubMed2001

Periumbilical necrotizing fasciitis in the newborn.

Periumbilical necrotizing fasciitis (PNF) in the newborn is an invasive bacterial infection of the abdominal wall with a fulminant course and a high mortality rate. Little is known about the etiology, risk factors and microbiology of the disease. 18 patients with periumbilical necrotizing fasciitis were included in this retrospective study and were compared with 50 patients with omphalitis over a 6-year period, between 1992 and 1998. This represents the largest reported study. The children with periumbilical necrotizing fasciitis presented at a younger age compared to the omphalitis group (8.4 days vs. 9.1 days) and had a shorter clinical history (1.9 days vs. 2.8 days), suggesting that PNF is not a mere sequela of omphalitis but has distinctive underlying causes. None of our patients in the omphalitis group had a progression of the disease towards necrotizing fasciitis. The microbial spectrum of cultures obtained in patients with PNF consisted of mixed anaerobes and aerobes in 55%, and mixed aerobes in 36% of cases. Early aggressive therapy, including elective endotracheal intubation, immediate surgical debridement of the abdominal wall, antibiotics and supportive measurements resulted in a survival rate of 56%. Far from being satisfactory, this is nevertheless higher than the 12.5% to 45% survival rate quoted in previous publications.

Bacterial Infections↗

PubMed1996

Management of necrotizing fasciitis in the neck.

Necrotizing fasciitis is a soft tissue infection, usually polymicrobial, characterized by necrosis of fascia and subcutaneous tissue. Although it more commonly involves the groin, abdomen, and extremities, it may also occur in the head and neck. We report a case of cervical necrotizing fasciitis arising from a dental infection and review the cause, pathophysiology, diagnosis and treatment of this potentially lethal entity. Early detection and accurate intervention are emphasized. Extensive surgical debridement completed with hyperbaric oxygen therapy and antibiotics are the mainstay of treatment.

Adult↗

PubMed1997

Necrotizing fasciitis after Plastibell circumcision.

Necrotizing fasciitis is a potentially life-threatening infection of subcutaneous tissues and Scarpa's fascia that rarely affects neonates. We report the occurrence of this devastating infection in two neonates after routine Plastibell circumcision. These case reports highlight the presentation and management of this complication after a relatively routine and frequently performed operation. This report also emphasizes the differences between cellulitis and necrotizing fasciitis and suggests strategies for management.

Anti-Bacterial Agents↗

PubMedDate not supplied

Rapidly fatal necrotizing fasciitis after aesthetic liposuction.

Necrotizing fasciitis (NF) is a rapidly progressive soft tissue infection involving primarily the superficial fascia and subcutaneous tissue. The disease is caused by Streptococcus pyogenes or synergistic infection of anaerobic and facultative anaerobic bacteria. Further characteristics are severe, intolerable pain and a mortality rate of 30 to 50%. The NF can be initiated after surgical procedures, minor trauma, trivial scratches, in the setting of a chronic wound, or even in apparently intact skin. The age of the patient is not relevant for the prognosis of NF. As it is shown in this reported case, a young and previously healthy patient died after aesthetic liposuction in the course of a NF. Necrotizing fasciitis is a rare disease, therefore, it is important to review its diagnostic and clinical features, because only early diagnosis and prompt, radical surgery improves the survival rate.

Adult↗

PubMed1997

Necrotizing fasciitis of the face.

Necrotizing fasciitis (NF) is a rapidly progressive soft tissue infection with high morbidity and mortality rates. Its occurrence in the head and neck region is uncommon, the majority of reported cases being limited to involvement of the neck, usually from infections of dental or pharyngeal origin. Involvement of the face from NF is rare; only 35 such cases have been reported in the literature since 1960. It is not only associated with a high mortality but can also result in severe disfigurement of the face, posing challenging reconstructive problems. Successful management of facial NF requires early diagnosis, prompt institution of broad spectrum antibiotics, aggressive surgical debridement to control the infection, and reconstruction of the resultant soft tissue defects. This report describes four additional cases of facial necrotizing fasciitis. One of the four patients died as a result of sepsis and multi-organ system failure. Two of the three surviving patients had significant facial disfigurement. A comprehensive review of the facial NF cases reported in the literature is also provided. Based on our experience with facial NF and the results of all previous case reports, the clinical manifestations, pathogenesis, and management of this disease are discussed.

Adult↗

PubMed2005

The hospital costs of treating necrotizing fasciitis.

BACKGROUND: Management of necrotizing fasciitis places significant demands upon hospital and medical resources. A successful management usually requires extensive surgical intervention and an adjunct hyperbaric oxygen treatment. The cost impact on the health care system has not been well characterized. We have, therefore, analysed the cost of treating this disease at an Australian tertiary referral hospital with extensive case experience and well-developed financial costing systems and have compared this with the current casemix-based government funding arrangements applying in Victoria, Australia. METHODS: Data was extracted from the medical records of 92 sequential patients treated by the Alfred Hospital (Melbourne, Australia) during the four financial years 2000-04. Clinical costing data and government funding data was provided by the hospital's Finance Departments. RESULTS: The total Alfred Hospital in-patient costs for treating the patients was $5,935,545 with a mean cost per patient of $64,517 (range, $1025 to $514,889). The total casemix-based funding allocation derived from treating these patients was calculated at $3,208,664 with the per patient mean $34,887 (range, $1331 to $387,168). This analysis does not include allowance for non-Alfred Hospital costs such as those incurred by the ambulance service, referring hospitals, for rehabilitation or as a result of the burden of residual disability. CONCLUSIONS: This study has confirmed that a significant economic burden is involved in treating necrotizing fasciitis. There is a substantial difference between the hospital costs and government funding for treating these patients in the Australian setting.

Diagnosis-Related Groups↗

PubMed1977

Erysipelas and necrotizing fasciitis.

The clinical course of necrotizing fasciitis in 8 patients is compared with observations on 22 other patients with erysipelas. In necrotizing fasciitis the early erythematous areas turn into a dusky blue colour with later vesiculation and formation of bullae. An important finding is a non-pitting oedema extending outside the erythematous patches. The disease often progresses and involves further skin areas proximal to the initial ones. Gangrene tends to follow in multiple sites after the 1st week of illness. Group A streptococci in conjunction with widespread thrombosis and vascular necrosis of the involved skin are two major factors in the pathogenesis of the gangrene. Early debridement and excision of necrotic tissue in combination with large doses of penicillin and cloxacillin are confirmed as mandatory to remove toxaemia and inhibit further necrosis of the skin. In 3 of the 8 patients with necrotizing fasciitis the syndrome of disseminated intravascular coagulation complicated the course of the disease. A promising therapeutic result was seen in 2 further patients exhibiting alarming signs and symptoms of early necrotizing fasciitis; the combination of heparin, given intravenously in therapeutic doses guided by activated partial thromboplastin time studies, and of systemic antibiotics alleviated the symptoms, which vanished within 10 days of the start of treatment.

Adolescent↗

PubMed2006

Necrotizing fasciitis in rheumatic diseases.

Necrotizing fasciitis is an uncommon but life-threatening complication in immunocompromised hosts. We reported four patients with rheumatic diseases complicated by necrotizing fasciitis and reviewed 14 others from literature search. Most patients were on corticosteroid treatment. Septic shock, disseminated intravascular coagulopathy and acute renal deterioration were common giving rise to an overall mortality rate of 27.8%. Septic arthritis may also complicate the condition. Statistical analysis on the series showed the lack of major surgical debridement as the only risk factor associated with increased mortality (RR 7.5, 95% CI 2.1-27.3, P = 0.01). Timely debridement of necrotic tissue is important for reducing mortality.

Adult↗