A rare case of primary necrotising fasciitis of the breast: combined use of hyperbaric oxygen and negative pressure wound therapy to conserve the breast. Review of literature

Abstract

Necrotising fasciitis is a rare but potentially fatal disease. It is even more unusual as a primary disease of the breast. Surgical treatment is required in order to gain control over the spreading infection and mastectomy is reported to be the most common procedure. We report the first case of an otherwise healthy woman exhibiting a primary necrotising fasciitis of the breast, which was treated combining conservative surgery with hyperbaric oxygen (HO) and negative pressure wound therapy (NPWT). A 39-year-old woman presented to the emergency room with fever and swelling of her right breast. The physical examination showed oedema and erythema of the breast, with bluish blisters on the lower quadrant. Ultrasound and CT scans showed diffuse oedema of the entire right breast, with subdermal gas bubbles extending to the fascial planes. Few hours later the necrotic area extended regardless an IV antibiotic therapy; a selective debridement of all breast necrotic tissue was performed and repeated 7 days later. The HO was started immediately after the first surgery and repeated daily (2·8 Bar, 120 min) for 18 days and then a NPWT (120-135 mmHg) was applied. Forty-five days after the last debridement, the breast wound was covered with a full-thickness skin graft. Several months later, an excellent cosmetic result was observed. This is the first case of primary necrotising fasciitis of the breast treated associating HO and NPWT to surgical debridement only; this combination resulted in a complete recovery with the additional benefit of breast conservation. Such result is discussed in light of the available literature on the treatment of primary necrotising fasciitis of the breast.

A case report of primary necrotising fasciitis of the breast: A rare but deadly entity requiring rapid surgical management

“…It was first described in the literature by Shah et al in 2001, and only a handful of cases have since been published [12] . Of these, there are only 6 reports of primary necrotizing fasciitis of the breast (PNFB) occurring in non-lactating, previously healthy women [2] , [3] , [4] , [5] , [6] , [7] ( Table 1 ). The most recent of these reports have utilized staged debridements rather than immediate mastectomy as a treatment strategy.…”

“…To date, just twelve case reports detailing necrotizing fasciitis of the breast exist in the literature. Of these, only six reports feature primary, idiopathic necrotizing fasciitis of the breast in previously well, non-lactating women [2] , [3] , [4] , [5] , [6] , [7] . We present a case of primary necrotizing fasciitis of the breast in a healthy 23 year old female.…”

Necrotizing Fasciitis of the Breast: A Case Report and Literature Review

“…Necrotizing fasciitis was first described by Hippocrates in the fifth century and later defined by Wilson in 1952 as an infective process resulting in necrosis of the fascia and subcutaneous tissue with sparing of the muscle [1][2][3]. It is a rapidly progressing, potentially fatal bacterial infection that spreads along fascial planes [4]. The production of bacterial toxins leads to widespread necrosis of tissue adjacent to the fascial planes and can subsequently lead to systemic toxicity and sepsis [2,5].…”

Abstract Journal Rural Surgery

“…It can be challenging diagnostically and surgically. Mastectomy is reported to be the main treatment for majority of cases in the published literature (2).…”

“…Necrotizing fasciitis of the breast can be a challenging diagnosis, often masquerading as mastitis or breast abscess (1,2). A high index of suspicion and treatment at first point of contact is critical.…”