Necrotizing Fasciitis of the Upper Extremity, Case Report and Review of the Literature

Nazerani, Shahram; Maghari, Ahmad; Motamedi, Mohammad Hosein Kalantar; Ardakani, Jalal Vahedian; Rashidian, Nikdokht; Nazerani, Tina

doi:10.5812/traumamon.6398

Cited by 10 publications

(4 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…49 From the reviewed literature, 30 studies including 255 patients with upper limb NF provided detailed information about culture results. 5,6,8,10,[13][14][15][16][17][21][22][23][24][26][27][28][29][30][31][32][33][35][36][37][38][39]41,[43][44][45] The cultures obtained were positive in 232 patients (91%). An explicit predominance of Type 2 NF can be noticed, confirming the divergence of upper extremity NF compared to NF affecting other anatomic sites in terms of microbiology.…”

Section: Microbiologymentioning

confidence: 99%

Necrotizing Fasciitis of the Upper Extremity – A Review

Δίτσιος

Chitas

Christidis³

et al. 2022

Orthopedic Reviews

View full text Add to dashboard Cite

Necrotizing fasciitis is a soft tissue infection that habitually originates from the fascial sheaths, expands at a volant pace, leads to extensive necrosis of the subcutaneous tissues, and eventually ends up in a life-threatening condition with notably elevated amputation and mortality rates. Factors that induce interruption of skin integrity, such as trauma or intravenous drug use, are the most common inciting events. Specific clinical signs heralding its presence are usually absent in the early stages, often resulting in misdiagnosis. Early recognition, prompt and aggressive surgical debridement, antibiotic use, and supportive care constitute the fundamental principles to lean on for a better prognosis. Necrotizing fasciitis of the upper extremity is relatively rare and consequently holds a limited place in the literature. Only a few studies assess it as a separate entity, with most of them being case reports or small case series. We, therefore, performed a review of the current literature, to assemble the dispersed results of different studies and clarify the various aspects of upper limb necrotizing fasciitis. In this systematic review, we present the epidemiological data, the causative events, the most frequent underlying diseases, the risk factors, the amputation and mortality rates, the pathogenic microorganisms, the clinical characteristics, the diagnostic tools, the medical and surgical management concerning necrotizing fasciitis of the upper limb. Finally, the results indicating its differentiation compared to necrotizing fasciitis of other anatomic sites are remarkably highlighted.

show abstract

Section: Microbiologymentioning

confidence: 99%

Necrotizing Fasciitis of the Upper Extremity – A Review

Δίτσιος

Chitas

Christidis³

et al. 2022

Orthopedic Reviews

View full text Add to dashboard Cite

show abstract

“…4 Upper extremity infections represent approximately 10-38% of necrotizing fasciitis. [5][6][7][8] Mortality estimates range from 8.7% to 76%, though without treatment, that number rises to about 100%. 4 Recent literature delineates four subtypes of necrotizing fasciitis: Type I synergistic necrotizing fasciitis results from the effects of aerobes, anaerobes, and facultative anaerobes.…”

Section: Introductionmentioning

confidence: 99%

Necrotizing Fasciitis of the Upper Extremity: A Systematic Review of the Literature

Bilolikar,

Rengifo,

Desai

et al. 2023

SurgiColl

View full text Add to dashboard Cite

Objectives Through this review, we sought to accomplish two goals: 1) analyze and synthesize the published case reports on upper extremity necrotizing fasciitis and 2) identify any trends in the diagnosis and treatment of upper extremity necrotizing fasciitis. Methods Studies included in this systematic review were conducted per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with the following eligibility criteria: (1) single case or limited case series, (2) established diagnosis of necrotizing fasciitis in the hand, wrist, or forearm, (3) English language publication. Results Most of the patients in this review (38, (70.37%)) presented with an inciting injury. A minority of patients had other associated co-morbidities independent of injury, including Diabetes Mellitus, immunosuppression, and IV drug use. The most common infectious agents were gram-positive cocci, identified in 32 (59.26%) cases, followed by gram-negative bacilli in 21 (38.89%) cases. The most common pathogen was Group A streptococcus (GAS), reported in 15 (27.78%) cases, followed by Vibrio vulnificus in 6 (11.11%) cases. Most patients were managed with empiric antibiotic treatment. Fifty patients (92.6%) reported surgical intervention and 45 (83.3%) had at least one debridement. Most patients in the cases reviewed had either no or minimal long-term sequelae following their infection. Conclusion Early recognition of the signs and symptoms of necrotizing fasciitis is imperative to avoid loss of limb and/or death. Further, aggressive management with empiric antibiotic coverage and rapid surgical intervention improves outcomes in patients with necrotizing fasciitis of the upper extremity.

show abstract

“…It is a rapid and serious infection of the dermis, subcutaneous tissue, fat, superficial fascia, deep fascia, and with or without involving muscles causing their necrosis. Risk factors include age more than 60 years, chronic diseases (such as (diabetes mellitus and renal failure), trauma, and surgeries [ 1 , 2 ]. Treatment constitutes antibiotics, fluid correction, and thorough debridement.…”

Section: Introductionmentioning

confidence: 99%

Management of Necrotizing Fasciitis with Proximal Tibia Fracture

Patil¹,

Kumar²,

Rao³

et al. 2021

JOCR

View full text Add to dashboard Cite

Introduction: Necrotizing fasciitis is a rare disease of soft tissue infection with a high mortality. It is characterized by rapidly spreading inflammation and necrosis of fascial planes. It usually follows an injury, though the cause may be a small abrasion or an insect bite or surgical incisions. It is commonly caused by bacteria such as Group A streptococcus. It may be accompanied by septic shock. It causes rapid death unless it is diagnosed quickly and managed aggressively. Prompt surgical debridement must be done to reduce mortality. Rapid diagnosis, antibiotic therapy, fluid resuscitation, and surgical debridement of the infection are all needed in the management of this fatal disease. However, when necrotizing fasciitis is associated with an underlying fracture the treatment becomes even challenging and limb-threatening. Case Report: A 48-year-male patient of South Asian descent came to Emergency Room with history of road traffic accident and sustained injury to the right (RT) leg. He was admitted with pain, swelling and blisters of the RT leg and suspected to have necrotizing fasciitis with proximal tibia fracture of the RT leg. He was treated with thorough surgical debridement, broad-spectrum antibiotics, free flap, and Masquelet’s technique with limb reconstruction system (LRS). At 18 months of follow-up the fracture healed, LRS was removed, pin tracts healed and patient was able to walk without any support. Conclusion: Necrotizing fasciitis is rare, rapidly progressive disease with a high mortality rate which requires prompt diagnosis, early surgical debridement, broad-spectrum antibiotics, careful fluid, and electrolyte management. These patients require a combined multidisciplinary approach for their management. Keywords: Necrotizing fasciitis, proximal tibia fracture, surgical debridement.

show abstract

Necrotizing Fasciitis of the Upper Extremity, Case Report and Review of the Literature

Cited by 10 publications

References 14 publications

Necrotizing Fasciitis of the Upper Extremity – A Review

Necrotizing Fasciitis of the Upper Extremity – A Review

Necrotizing Fasciitis of the Upper Extremity: A Systematic Review of the Literature

Management of Necrotizing Fasciitis with Proximal Tibia Fracture

Contact Info

Product

Resources

About