Approach to debridement in necrotizing fasciitis

Wong, Chin‐Ho; Yam, Andrew; Tan, Augustine H. H.; Song, Colin

doi:10.1016/j.amjsurg.2007.08.076

Cited by 86 publications

(65 citation statements)

References 16 publications

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“…NF is a rapidly progressive, highly destructive bacterial infection involving the skin, s.c. and deep soft tissues, and muscles that are referred to collectively in this article as soft tissues. Clinical studies demonstrated that a prompt surgical debridement of the infected soft tissues is critical for the patient's better outcome (3). Yet, mortality from GAS NF remains high and, in some reports, exceeds 50% (4).…”

mentioning

confidence: 99%

Recruited Macrophages Control Dissemination of Group A Streptococcus from Infected Soft Tissues

Mishalian

Ordan

Peled³

et al. 2011

The Journal of Immunology

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Group A Streptococcus (GAS) causes diverse infections in humans, ranging from mild to life-threatening invasive diseases, such as necrotizing fasciitis (NF), a rapidly progressing deep tissue infection. Despite prompt treatments, NF remains a significant cause of morbidity and mortality, even in previously healthy individuals. The early recruitment of leukocytes is crucial to the outcome of NF; however, although the role of polymorphonuclear neutrophils (PMNs) in host defense against NF is well established, the role of recruited macrophages remains poorly defined. Using a cutaneous murine model mimicking human NF, we found that mice deficient in TNF-α were highly susceptible to s.c. infections with GAS, and a paucity of macrophages, but not PMNs, was demonstrated. To test whether the effects of TNF-α on the outcome of infection are mediated by macrophages/monocytes, we systemically depleted C57BL/6 mice of monocytes by pharmacological and genetic approaches. Systemic monocyte depletion substantially increased bacterial dissemination from soft tissues without affecting the number of recruited PMNs or altering the bacterial loads in soft tissues. Enhanced GAS dissemination could be reverted by either i.v. injection of monocytes or s.c. administration of peritoneal macrophages. These experiments demonstrated that recruited macrophages play a key role in defense against the extracellular pathogen GAS by limiting its spread from soft tissues.

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mentioning

confidence: 99%

Recruited Macrophages Control Dissemination of Group A Streptococcus from Infected Soft Tissues

Mishalian

Ordan

Peled³

et al. 2011

The Journal of Immunology

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“…Patient's condition may require repetition of removal of new-found necrotic tissue. Delayed suture is recommended, as well is fasciotomy (if it is feasible) and wound revision in each 2 h within the first 2 days [9].…”

Section: Discussionmentioning

confidence: 99%

Fatal necrotizing fasciitis following two suicide attempts with petroleum oil injection

Hady

Mikucka

Gołaszewski

et al. 2010

Langenbecks Arch Surg

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“…Advocates of one-stage debridement base their case on a review of 21 cases of necrotizing fasciitis in Singapore, but unfortunately, the causative agents were not noted [77]. The authors argue that "patients are severely septic and complete removal of all infected tissue is the only way to rapidly reverse the sepsis."…”

Section: Surgerymentioning

confidence: 97%

“…The authors argue that "patients are severely septic and complete removal of all infected tissue is the only way to rapidly reverse the sepsis." Extending the margins of excision to further than seems initially necessary, with ingress into apparently normal skin and leaving a 5 to 10-mm margin of healthy fascia, creates a "firebreak" halting spread of infection [77].…”

Section: Surgerymentioning

confidence: 99%