Necrotizing Soft Tissue Infections of the Perineum

Kline, Bryan P.; Jeganathan, Nimalan A

doi:10.1055/s-0041-1740102

Cited by 5 publications

(22 citation statements)

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“…NSTI encompass a group of destructive soft tissue bacterial necrotic disease processes, which can involve skin, subcutaneous fat, fascia(s) and/or muscle(s), associated with rapid spread along tissue planes, systemic toxicity and potentiality for high mortality [11,12,[16][17][18][19][20][21][22].Although NSTIs have some common clinical features, various entities have been recognized, such as streptococcal gangrene, gas gangrene (clostridial myonecrosis), synergistic necrotizing cellulitis and progressive bacterial synergistic gangrene [5]. Subtle differences may distinguish one entity from another, but the clinical approach to diagnosis and treatment is similar.…”

Section: Nsti Disease: Overview and Current Conceptsmentioning

confidence: 99%

“…injure, scrape), where the organisms enter the soft tissue causing local infection, or (ii) occurring when a non-penetrating tissue injury (i.e. hematoma, muscle sprain) is infected by transient bacteremia, usually originating from the gastrointestinal or genitourinary tract [5,17,20,22,23]. A secondary infection by the host's own indigenous aerobic or anaerobic microflora usually leads to polymicrobial infection [4][5][6]14,16].…”

Section: Pathophysiology -Mechanisms Of Evolution Of the Diseasementioning

confidence: 99%

“…High-protein fluid exudates out of the blood vessels into the soft tissue and accumulates along the deep fascia [1,20]. Hypoxia and ischaemic destruction of the subcutaneous tissue and the deep fascia ensues as the process progresses, resulting in extensive necrosis and liquefaction of the fascias and the surrounding tissues [1,14,20].The most prominent affected skin areas might be in discrepancy with the position of the fascial necrosis [3].Typically, the disease is characterized by sudden onset, spreads along existing fascial planes, and deteriorates rapidly [22,23]. It is not associated with an abscess, but if an abscess is left untreated or is inadequately drained, it may transition to progressive necrotizing infection [4].…”

Section: Pathophysiology -Mechanisms Of Evolution Of the Diseasementioning

confidence: 99%

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Contemporary strategies for diagnosis and management of necrotizing soft tissue infections: Α review

Avgoustou¹

2023

World J. Adv. Res. Rev.

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The necrotizing soft tissue infection (NSTI) is an uncommon but rapidly progressive destructive disease associated with high mortality. In this study, we review basic knowledge and emphasize contemporary perspectives in diagnosis and treatment of adult NSTI. The mainstays of management of NSTI that can modify outcomes are the awareness for early detection and that all aspects of multidisciplinary treatment should be started promptly and simultaneously. Surgical debridement entails aggressive approach with extensive, and, if required, repeat necrectomies to completely control advancing sepsis in soft tissues. There is general agreement that the principles of damage control surgery should be applied on deranged NSTI patients. Continuous supportive care and scheduled management of residual open wounds are considered as extremely important. It has also been recognized that relative clinical guidelines and recommendations are growing in number and may vary widely in quality. Notably, the compliance of therapists to given guidelines differs among studies, and variations in aspects of clinical practice exist. Many studies comprise small numbers of patients, making evaluation of proposed novel techniques or adjuncts unreliable. Concluding, NSTI diagnosis should be promptly established, surgery should never be delayed so that sepsis remains reversible, and supportive care should be continuous. Novel therapeutics are required to combat this persistently lethal disease, thus, the next research steps should focus on determining if optimization of modifiable predictors would improve outcomes. Stronger well-conducted studies and wider dissemination of developed evidence-based instructions, while ensuring the strict compliance of daily clinicians’ practices, are required to further improve outcomes.

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Section: Nsti Disease: Overview and Current Conceptsmentioning

confidence: 99%

Section: Pathophysiology -Mechanisms Of Evolution Of the Diseasementioning

confidence: 99%

Section: Pathophysiology -Mechanisms Of Evolution Of the Diseasementioning

confidence: 99%

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Contemporary strategies for diagnosis and management of necrotizing soft tissue infections: Α review

Avgoustou¹

2023

World J. Adv. Res. Rev.

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“…Necrotizing neutrophilic dermatosis (NND) represents the emerging term given to the subset of ND cases accompanied by severe systemic inflammation and accompanying shock [ 3 ]. The alternate differential diagnosis for an erythematous and/or painful rash in conjunction with systemic toxicity is a necrotizing soft tissue infection (NSTI), a highly lethal condition requiring emergent and often extensive surgical debridement to prevent certain mortality [ 4 ]. Given the rapid progression shared by both NND and NSTI along with their markedly divergent management strategies, parsing out the correct diagnosis is of paramount importance for clinicians [ 3 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…NND: necrotizing neutrophilic dermatosis; NSTI: necrotizing soft tissue infection[4,5,10,[13][14][15][16].…”

mentioning

confidence: 99%

A Case Report of Necrotizing Neutrophilic Dermatosis: A Sheep in Wolf’s Clothing

Ackerman¹,

Phan²,

Kuroki³

et al. 2022

Cureus

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Neutrophilic dermatosis (ND) is a category of diseases characterized by trauma-induced, autoinflammatory cutaneous eruption. Comorbid systemic disease is common with a predilection for malignancy, inflammatory bowel disease, and rheumatologic disease. Rarely, it can manifest with aseptic shock, an entity referred to as necrotizing neutrophilic dermatosis (NND). NND may occur in the postoperative setting and is often misdiagnosed as a necrotizing soft tissue infection. Unfortunately, the treatment for a necrotizing soft tissue infection, namely, wide debridement, is often detrimental in the setting of NND. We present the case of a woman with underlying myelodysplastic syndrome who developed episodic postoperative hemodynamic collapse followed by delayed necrotic peristomal ulceration following colonic diversion for complicated diverticulitis. Infectious workup and operative re-exploration were unrevealing. Pathologic assessment of affected skin tissue showed changes consistent with ND, ultimately leading to the diagnosis of NND. Her clinical course dramatically improved with the initiation of immunosuppressive therapy. The mimicry of NND to a potentially lethal necrotizing soft-tissue infection creates a grave diagnostic dilemma in the postoperative period. A general lack of knowledge of NND among nondermatologic specialists produces an opportunity for misdiagnosis and inappropriate surgical interventions, namely, serial debridement. Several clinical cues may aid in the earlier recognition of NND. The cornerstone of treatment involves systemic corticosteroid therapy with adjunctive therapy for refractory cases. NND must be considered in the differential diagnosis of necrotizing soft tissue infection as early recognition may result in the avoidance of deleterious surgical interventions.

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Management of an elderly patient with retention of a steel nail in the scrotum: a case report

Meneghetti,

Cesta,

Mosillo

et al. 2024

Arch Ital Urol Androl

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Background: The retention of foreign bodies inside the body during ludic/sexual procedures or for traumatism represents one of the causes of visits to accident and emergency departments that often requires surgical removal of the foreign body. However, there are cases where the discovery of such foreign bodies takes place after many years, as in patients that are slightly compromised from a neuro-sociological point of view. Case presentation: A 76-year-old male presented to an outpatient urological examination due to an increase in scrotal volume. At the ultrasound check, an acoustic interference from a solid object was detected, for which computed tomography was requested. The computed tomography scan revealed the presence of an elongated metal body in the perineum. The removal of the foreign body in the operating theatre was then scheduled. A 10 cm long stainless-steel nail located within an abscessed foreign body granuloma was identified and removed via a scrotal access. Four days later, a new surgical toilet was performed due to minimal necrosis of the skin flaps. The patient then performed three more dressings in the operating theatre during the following week. Healing took place by secondary intention until a perfect healing of the surgical wound was obtained. Conclusions: Removal of foreign bodies from the perineum in case of infection can be challenging. Careful attention and postoperative dressings are crucial for the success of the case.

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Necrotizing Soft Tissue Infections of the Perineum

Cited by 5 publications

References 50 publications

Contemporary strategies for diagnosis and management of necrotizing soft tissue infections: Α review

Contemporary strategies for diagnosis and management of necrotizing soft tissue infections: Α review

A Case Report of Necrotizing Neutrophilic Dermatosis: A Sheep in Wolf’s Clothing

Management of an elderly patient with retention of a steel nail in the scrotum: a case report

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