A case report of successful treatment of necrotizing fasciitis using negative pressure wound therapy

Paula, Fabiana Martins de; Pinheiro, Edivânia Anacleto; Oliveira, Vanessa Marcon de; Ferreira, Cristiane Munaretto; Monreal, Maria Tereza Ferreira Duenhas; Rolan, Marisa Dias; Matos, Vanessa Terezinha Gubert de

doi:10.1097/md.0000000000013283

Cited by 16 publications

(16 citation statements)

References 21 publications

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“…When NF is suspected or diagnosed, in order to preserve viable skin and achieve hemostasis, promptly surgical removal of all necrotic tissue, including muscle, fascia, and skin is necessary, what we also proved in our case. [11,12] Affected tissues should be carefully resected until only the healthy tissues remain intact. This should be continued daily, as long as the surgical team determines that all necrotic tissues have been removed.…”

Section: Discussionmentioning

confidence: 99%

Necrotizing fasciitis after total abdominal hysterectomy: A case report

Pantelić,

Stojić,

Petrović

et al. 2023

Medicine

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Rationale: Necrotizing fasciitis is rapidly progressive infection with high mortality rate. This study aimed to summarize the clinical and pathological presentation of this case. Patient concerns: A 46-year-old woman patient presented to our emergency department of an obstetric and gynecology clinic on the 8th day after total abdominal hysterectomy. The abdominal wall showed pronounced signs of inflammation. Abundant purulent content was oozing from the abdominal wound. Diagnoses: The patient underwent surgery. Areas of necrosis were observed on the skin around the wound, the subcutaneous fatty tissue was necrotic around the incision site, and the fascia was completely dehisced. Interventions: Wound debridement and flap cutting of the anterior abdominal wall were performed. Metronidazole, ceftriaxone, and vancomycin were administered intravenously. A plastic surgeon suggested daily debridement and toileting of the wound in the operating room. Swabs of the abdominal cavity, abscess cavity, and abdominal wound were obtained, and Enterococcus faecalis was isolated. After the negativism of microbiological swabs, excochleation of granulation tissue was performed by a plastic surgeon. Outcomes: Nineteen days after the relaparotomy, the patient was discharged in good general condition with advice for further monitoring and therapy. Lessons: Successful treatment of necrotizing fasciitis can be achieved through an initial diagnosis, adequate debridement, empirical broad-spectrum antibiotic coverage, and multidisciplinary treatment.

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Section: Discussionmentioning

confidence: 99%

Necrotizing fasciitis after total abdominal hysterectomy: A case report

Pantelić,

Stojić,

Petrović

et al. 2023

Medicine

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“…The advantages of NPWT include persistent and complete drainage, effective infection control, reduced postoperative secondary necrosis, formation of new granulomatous tissue, and significant short-term improvement in wound status. [31][32][33] Some researchers have also suggested that NPWT reduces the incidence of septic shock, and organ failure. 31,34,35 Clinical diagnosis is particularly important in the treatment of NF, and a comprehensive diagnosis should be made in conjunction with the results of laboratory tests.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Key Points and Surgical Management of Necrotizing Fasciitis: A Retrospective Study

Sun

Lin

et al. 2021

The International Journal of Lower Extremity Wounds

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Necrotizing fasciitis (NF) is a fatal disease with a high mortality rate that can be easily misdiagnosed. The aim of this study was to improve the diagnostic rate of NF and overall survival. We conducted a single-center, retrospective, noncontrolled study involving 36 patients who were admitted to our department between December 2017 and October 2019, and summarized the diagnostic key points and timing of surgical treatment. All patients were diagnosed at our department and underwent multiple courses of treatment. The records included information regarding underlying diseases, bacterial culture results, laboratory risk indicator for necrotizing fasciitis (LRINEC) score, number of procedures, and type of antibiotics. All 36 cases of NF were cured and showed good patient condition on follow-up; the mean number of surgeries was three, and the mean duration of hospitalization was 37 days (range, 21-83 days). The LRINEC scores of 16 patients were ≥8 points. Seventeen patients with underlying diabetic disease had higher inflammatory index scores than those without diabetes. The LRINEC scores of patients with ( n = 17) and without ( n = 19) DM were 7.40 ± 2.99 and 3.80 ± 2.39, respectively ( P < .01). Cases of NF that were treated with early incision and surgical abscess drainage required fewer surgeries and a shorter length of hospitalization. Thus, surgeons should be more aware of NF and aim to make an early and accurate diagnosis using various approaches. Complete surgical debridement plays an essential role in NF treatment, and diabetes mellitus is a significant adverse factor that exacerbates the severity of NF. Negative-pressure techniques are useful in cases involving nonanaerobic infections and cause minimal complications.

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“…It is aimed at the removal of all the necrotic tissues, which include muscle, fascia, and skin, to preserve the viable skin. 13 A combination of surgical debridement, appropriate antibiotics, and optimal oxygenation of the infected tissues is necessary for the successful treatment of the condition. Broad-spectrum antibiotic combinations against anaerobic, gram-negative, and gram-positive bacilli are to be administered in the patient.…”

Section: Discussionmentioning

confidence: 99%

A case report on necrotizing fasciitis in a hemiplegic patient following an intra-muscular injection

Mendem

Faraz

Rao

2020

Int J Community Med Public Health

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Necrotizing fasciitis (NF) can be defined as a surgical emergency causing the necrosis of the skin, subcutaneous fat, and superficial fascia. It spreads along the fascial planes with or without the presence of cellulitis. It is characterized by the destruction of tissue, systemic toxicity, and may even lead to morbidity and mortality. Higher rates of prevalence were observed in the obese, diabetic, alcoholic, patients with peripheral vascular diseases and immunocompromised populations. There are no definite diagnostic criteria for NF and the laboratory findings may lead to misdiagnosis as cellulitis or abscess. It is usually developed from an injury to the skin, which may occur during trauma, IV drug use, drug administration (via injection), skin infections, ulcer, insect bites, visceral-cutaneous fistulas, surgical complications, percutaneous catheter insertion, abscesses and can even have idiopathic causes. Early diagnosis of the condition, surgical debridement, and optimal antibiotic therapy leads to the improvement in the condition and desired outcomes in the patient. The present study is focused on the successful treatment of necrotizing fasciitis in a hypertensive and hemiplegic patient, following an IM injection of an analgesic, which caused an ulcer and rapidly progressed, leading to necrosis of the affected regions.

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A case report of successful treatment of necrotizing fasciitis using negative pressure wound therapy

Cited by 16 publications

References 21 publications

Necrotizing fasciitis after total abdominal hysterectomy: A case report

Necrotizing fasciitis after total abdominal hysterectomy: A case report

Diagnostic Key Points and Surgical Management of Necrotizing Fasciitis: A Retrospective Study

A case report on necrotizing fasciitis in a hemiplegic patient following an intra-muscular injection

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