Management of Necrotizing Fasciitis and Its Surgical Aspects

Abstract

Necrotizing fasciitis (NF) is a severe and rapidly progressive infectious disease that attacks superficial an as well as deep fascia, subcutaneous fat tissue, and muscle. Although the incidence is of relatively low frequency, the median mortality is high. NF is a great burden to patients and hospitals. The most common cause of NF is trauma injuries, followed by other conditions with comorbidity. A classification for NF was presented concerning microbial cause, depth of infection, and anatomy. But the value of classification is not convincing. Early diagnosis of NF is essential and still to be realized by far. Information from clinic or laboratory might contribute to the purpose. Surgery is used in exploration debridement and tissue reconstruction as the main method with NF. Negative pressure wound therapy has proved to be useful in improving wound bed preparation and healing.

FatalAcinetobacter baumaniiNecrotizing Fasciitis following Open Reduction Internal Fixation in a Polytrauma Patient

“…NF is an exceedingly rare clinical entity, with an estimated 1000 cases annually in the United States with an increase of 35% in hospitalizations between 2001 and 2010 [ 1 ].…”

“…Necrotizing fasciitis (NF) is a rare, life-threatening bacterial infection leading to necrosis of the fascia, underlying skin, subcutaneous tissue, and vasculature associated with high morbidity and mortality. Necrotizing fasciitis could affect the perineum, the genital area, and most commonly the lower extremities [ 1 – 3 ], with a male-to-female ratio of 3 : 1 in terms of predominance [ 1 ].…”

“…NF is often misdiagnosed as cellulitis or other similar skin and soft tissue infections such as erysipelas [ 1 ].…”

Intestinal Perforation by a Toothpick as Reason for Necrotizing Fasciitis

“…The low incidence of the disease and lack of typical clinical symptoms in its initial phase lead to misdiagnosis as either cellulitis, abscess or pyoderma 7 . “Red flags” for NF are hypotension, hemorrhagic bullae and pain out of proportion 8 . Non-specific signs such as erythema, edema and fever do not allow for a distinction between NF and other differential diagnosis such as phlegmons, erysipelas, cellulitis and pyomyositis 9 .…”

İntramüsküler steroid enjeksiyonu sonrasında gelişen ve sepsis ile komplike olmuş bir nekrotizan fasiit olgusunun başarılı tedavisi

“…Hastaların tedavisinde erken tanı, geniş spektrumlu antibiyotik tedavisi ve cerrahi debritman esastır. Tedaviye rağmen olguların %30'u hayatını kaybetmektedir 6,7 . Burada intramüsküler enjeksiyonu takiben gelişen ve tedavisi uzun süren komplike bir hastadaki sürecin sunulması amaçlanmıştır.…”