Shared Management of a Rare Necrotizing Soft Tissue Infection of the Breast

Keune, Jason D.; Melby, Spencer J.; Kirby, John P.; Aft, Rebecca

doi:10.1111/j.1524-4741.2009.00731.x

Cited by 25 publications

(21 citation statements)

References 9 publications

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“…USS findings usually reveal a thickening and irregularity of the fascia associated with fluid collections 5. CT can demonstrate the presence of subcutaneous gas and fat stranding 1. Although MRI can reveal the extent of deep tissue involvement in greater detail than any other imaging modality, it has a low specificity (46–86%) 3 5.…”

Section: Discussionmentioning

confidence: 99%

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Breast necrotising fasciitis managed by partial mastectomy

Kaczynski¹,

Dillon

Hilton

2012

Case Reports

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We present the case of a 75-year-old woman who presented with extensive breast cellulitis, which was thought to be secondary to a deep breast abscess. On admission the patient underwent debridement of the breast and broad-spectrum intravenous antibiotics were administered. However, during hospitalisation she developed sepsis, acute renal failure and required further debridements for the rapidly spreading necrotising fasciitis. Subsequently, a partial mastectomy was performed and the patient made an overall good postoperative recovery.

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Section: Discussionmentioning

confidence: 99%

“…The initial presentation varies from minor/mild soft tissue infections to severe forms of septic shock and multiorgan dysfunction syndrome 1. Mortality can be as high as 73%, but with the appropriate treatment can be reduced by 10% 2 3.…”

Section: Introductionmentioning

confidence: 99%

Breast necrotising fasciitis managed by partial mastectomy

Kaczynski¹,

Dillon

Hilton

2012

Case Reports

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“…The first case of NF of the breast was described by Shah in 2001 , and only 11 cases of PNFB (i.e. with no previous trauma or intervention) have been reported in the literature so far (Table ); among these, only 5 cases without any associated comorbidity are reported . The current case is the first described Italian case of PNFB in otherwise healthy patients, the second in Europe and the sixth reported in the English literature (Table ).…”

Section: Discussionmentioning

confidence: 72%

“…It is even more unusual as a primary disease of the breast, with no previous invasive procedure or other comorbid conditions. To the best of our knowledge, only 11 cases of spontaneous necrotising infection of the breast have been reported in the literature , and 5 of these were otherwise healthy women . Mastectomy is reported to be the main treatment in the published literature.…”

Section: Introductionmentioning

confidence: 99%

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

Marongiu

Buggi

Mingozzi

et al. 2016

International Wound Journal

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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.

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“…Among the 16 reported cases of breast NF, common risk factors include DM (3,6-9), history of an invasive breast procedure, and a history of breast cancer (6,(9)(10)(11)(12). Notably, however, no clear precipitating factor was identified in six reported cases (1,7,(13)(14)(15)(16).…”

Section: Discussionmentioning

confidence: 98%

Necrotizing Fasciitis of the Breast Requiring Emergent Radical Mastectomy

2016

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Necrotizing fasciitis is a rare, aggressive, soft-tissue infection that results in necrosis of skin, subcutaneous tissue, and fascia. It spreads rapidly and may progress to sepsis, multi-organ failure, and death. Predisposing conditions include diabetes, chronic alcoholism, advanced age, vascular disease, and immunosuppression and many cases are preceded by an injury or invasive procedure. Necrotizing soft-tissue infection of the breast is uncommon, with only a few reported cases in the literature. We present a 53-year-old diabetic woman who presented to the emergency room with several weeks of worsening breast and shoulder pain, swelling, and erythema. Upon formal evaluation by the surgical service, a necrotizing soft-tissue infection was suspected, and the patient was scheduled for emergent, surgical debridement. Because of the aggressive nature and high mortality of this disease, immediate surgical intervention, coupled with antibiotic therapy and physiologic support, is necessary to prevent complications and death.

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Shared Management of a Rare Necrotizing Soft Tissue Infection of the Breast

Cited by 25 publications

References 9 publications

Breast necrotising fasciitis managed by partial mastectomy

Breast necrotising fasciitis managed by partial mastectomy

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

Necrotizing Fasciitis of the Breast Requiring Emergent Radical Mastectomy

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