RESUMO
Objective: To observe the clinical efficacy of a new type of "firebreak" drainage with skin preservation in the treatment of Fournier's gangrene. Methods: This technique is suitable for patients with perianal necrotizing fasciitis who can tolerate surgery without large area of skin blackness and necrosis. Procedure and key points: (1) The dividing line between inflammatory tissue and normal tissue was determined according to imaging examination and intraoperative exploration; (2) The abscess cavity was cut along the most obvious part of the abscess fluctuation, with a long diameter of 3~4 cm and a short diameter of 1~2 cm; (3) Necrotic tissue was discreetly separated and removed from the main incision to the outer edge of the infection. A fusiform incision was made every 3 to 5 cm, with a long diameter of 2 to 3 cm and a short diameter of 1 cm, and discreetly separated until the normal tissue, and a hose was hung between the adjacent incisions for drainage. (4) Each adjacent edge cut between the stealth separation and hanging hose drainage, forming a "firebreak"; (5) Rinse the wound repeatedly; (6) If the infection invades the rectum, colostomy is performed as required. The case data of 11 patients with perianal necrotizing fasciitis admitted to the Second Affiliated Hospital of Nanjing University of Chinese Medicine from July 2019 to February 2023 were retrospectively analyzed. All patients were treated with emergency surgical debridement by "firebreak" drainage with skin preservation. Results: All 11 cases were cured with 100%. One case underwent multiple operations. The hospitalization time was 11-46 days, with an average of 22 days. The wound healing time was 28-75 days, with an average of 43 days. Except for 1 patient with trauma, all the other patients had no significant anal function injury after surgery. All the 11 patients recovered and were discharged from hospital with a median follow-up of 136 (115-413) days. Conclusions: The "firebreak" drainage based on skin preservation has the advantages of less trauma and faster recovery, and do not cause obvious anal function damage.
Assuntos
Drenagem , Gangrena de Fournier , Humanos , Gangrena de Fournier/cirurgia , Drenagem/métodos , Masculino , Resultado do Tratamento , Pessoa de Meia-Idade , Fasciite Necrosante/cirurgia , Feminino , Adulto , Desbridamento/métodos , Pele , Abscesso/cirurgiaRESUMO
BACKGROUND: Necrotizing fasciitis (NF) is a rare but potentially life-threatening soft tissue infection. The objective of this study was to assess the association between timely surgery within 6 h and hospital mortality in patients with limb NF, and to describe the trends in patients with NF, time to surgery and standardized mortality ratio (SMR) over 11 years. METHODS: This was a multicenter, retrospective cohort study of all intensive care unit patients who had emergency surgery within 24 h of hospitalization for limb NF between April 1, 2008 and March 31, 2019 in Hong Kong. Timely surgery was defined as the first surgical treatment within 6 h of initial hospitalization. Appropriate antibiotics were achieved if the patient was given antibiotic(s) for all documented pathogens prior to or on day of culture results. The primary outcome was hospital mortality. RESULTS: There were 495 patients (median age 62 years, 349 (70.5%) males) with limb NF treated by surgery within 24 h of hospitalization over the 11 years. Appropriate antibiotic(s) were used in 392 (79.2%) patients. There were 181 (36.5%) deaths. Timely surgery was not associated with hospital mortality (Relative Risk 0.89, 95% CI: 0.73 to 1.07) but admission year, advanced age, higher severity of illness, comorbidities, renal replacement therapy, vasopressor use, and type of surgery were significant predictors in the multivariable model. There was an upward trend in NF diagnosis (1.9 cases/year, 95% CI: 0.7 to 3.1; P < 0.01; R2 = 0.60) but there was no downward trend in median time to surgery (-0.2 h/year, 95% CI: -0.4 to 0.1; P = 0.16) or SMR (-0.02/year, 95% CI: -0.06 to 0.01; P = 0.22; R2 = 0.16). CONCLUSIONS: Among patients operated within 24 h, very early surgery within 6-12 h was not associated with survival. Increasing limb NF cases were reported each year but mortality remained high despite a high rate of appropriate antibiotic use and timely surgical intervention.
Assuntos
Antibacterianos , Fasciite Necrosante , Mortalidade Hospitalar , Humanos , Fasciite Necrosante/mortalidade , Fasciite Necrosante/cirurgia , Fasciite Necrosante/microbiologia , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , Antibacterianos/uso terapêutico , Hong Kong/epidemiologia , Infecções Comunitárias Adquiridas/mortalidade , Infecções Comunitárias Adquiridas/cirurgia , Infecções Comunitárias Adquiridas/microbiologia , Tempo para o Tratamento , Extremidades/cirurgia , Extremidades/patologia , Adulto , Unidades de Terapia Intensiva/estatística & dados numéricos , Idoso de 80 Anos ou maisRESUMO
OBJECTIVES: Necrotizing soft-tissue infection and necrotizing fasciitis of the upper limb are infrequent. Studies are rare, and often include other anatomical regions. The specificities and particularities of this pathology are not well known. The aim of this study was to report diagnosis and treatment aspects. METHODS: A retrospective study was conducted over 10 years on every patient treated for necrotizing fasciitis of the upper limb with clinical, bacteriological and histological confirmation. One hundred ninety-eight items were extracted for each patient concerning clinical, biological, radiological and therapeutic data. RESULTS: During 10 years, 24 patients were diagnosed with necrotizing fasciitis of the upper limb: 18 males, 6 females; mean age, 59.9 years; mean body mass index, 25. Local erythema, pain and fever were the most frequent symptoms. Skin necrosis was present in fewer than 40% of patients. Sixteen cases (66.6%) had prior skin lesions and/or an entry point on the limb. Ten had non-steroidal anti-inflammatory drug prescription before acute symptom onset (42%), requiring intensive care unit admission. Treatment comprised surgical resection, resuscitative measures, antibiotic therapy and reconstructive surgery. Seven patients (30.4%) had 1 session of cutaneous excision, and the others had more than 2. Microbiological analysis found mono-microbial beta-hemolytic group A streptococci (BHGAS) infection in 14 patients (58.4%). Antibiotics were prescribed in 91% of cases before surgery, and in 100% after. The most frequently prescribed substance was clindamycin (18 patients, 75%). Ten patients (42%) stayed in the intensive care unit during treatment. Seventeen patients (70.8%) had thin skin graft reconstruction, including 50% with dermal substitute. Five patients (20.8%) had partial upper limb amputation. Two patients (8.3%) died in the 30 days following diagnosis. CONCLUSIONS: The death rate in necrotizing fasciitis of the upper limb was rather low but the amputation rate was higher than in other locations. This study shows the specific clinical, biological and treatment features of this rare but serious pathology of the upper limb.
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Antibacterianos , Fasciite Necrosante , Extremidade Superior , Humanos , Masculino , Fasciite Necrosante/microbiologia , Fasciite Necrosante/terapia , Fasciite Necrosante/cirurgia , Pessoa de Meia-Idade , Feminino , Estudos Retrospectivos , Idoso , Extremidade Superior/cirurgia , Extremidade Superior/microbiologia , Adulto , Antibacterianos/uso terapêutico , Desbridamento , Infecções dos Tecidos Moles/microbiologia , Infecções dos Tecidos Moles/terapia , Idoso de 80 Anos ou mais , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/terapiaRESUMO
Necrotizing fasciitis (NF) is a potentially life-threatening surgical emergency. It is a rapidly progressive infection of soft tissues, and mortality is related to the degree of sepsis and the general condition of the patient. It is a rare condition that requires a rapid diagnosis and surgical treatment is aggressive debridement. There are a small number of reported cases of perforation of a rectal malignancy leading to NF of the thigh. We present a case with rectal cancer in which the sciatic foramen had provided a channel for the spread of pelvic infection into the thigh.
La fascitis necrotizante es una emergencia quirúrgica potencialmente mortal. Es una infección de tejidos blandos rápidamente progresiva y la mortalidad está relacionada con el grado de sepsis y el estado general del paciente. Es una condición poco común que requiere un diagnóstico rápido, y el tratamiento quirúrgico consiste en un desbridamiento agresivo. Existe un pequeño número de casos notificados de perforación de neoplasia maligna de recto que conduce a fascitis necrotizante del muslo. Presentamos un caso de cáncer de recto en el cual el foramen ciático fue el canal para la propagación de la infección pélvica al muslo.
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Fasciite Necrosante , Perfuração Intestinal , Neoplasias Retais , Coxa da Perna , Humanos , Fasciite Necrosante/etiologia , Fasciite Necrosante/cirurgia , Neoplasias Retais/cirurgia , Neoplasias Retais/complicações , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Masculino , Desbridamento , Adenocarcinoma/complicações , Adenocarcinoma/cirurgia , Pessoa de Meia-Idade , Nervo Isquiático/lesões , Infecção Pélvica/etiologiaRESUMO
OBJECTIVE: To assess the predictive ability of the laboratory risk indicator for necrotising fasciitis (LRINEC) score for lower extremity amputation in patients with moderate to severe diabetic foot infection (DFI). STUDY DESIGN: Observational study. Place and Duration of the Study: Department of General Surgery, Combined Military Hospital, Rawalpindi, Pakistan, from June to September 2023. METHODOLOGY: Patients admitted to the surgical ward with moderate to severe DFI were included by convenience sampling. Patients with severe sepsis, unstable haemodynamics, pressure injuries, and terminal illnesses were excluded. Demographic and clinical data of patients were noted down. LRINEC score was calculated on the day of admission. Final outcome (amputation or otherwise) was recorded on the 30th day the since the day of admission. RESULTS: Two hundred patients with moderate to severe DFI were included. The median age of patients was 56 years (IQR 49-66 years). The median duration of diabetes was 11 years (IQR 4 - 18.75 years). The median LRINEC score at admission was 6 (IQR 3-9). The majority of the patients (65.5%) had some other medical comorbid besides diabetes. Patients who had amputation due to DFI at 30 days post-admission had higher LRINEC scores on admission as compared to those patients who did not have amputation (Median 8 vs. 2, p <0.001). The cut-off point of LRINEC score ≥6.5 at admission had sensitivity of 74% and specificity of 94% in predicting amputation. CONCLUSION: The LRINEC score may be used as an objective scoring system to predict the risk of amputation in patients with moderate to severe DFI in indoor clinical settings. KEY WORDS: Diabetic foot, LRINEC score, Limb loss, Necrotising fasciitis.
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Diabetes Mellitus , Pé Diabético , Fasciite Necrosante , Dermatopatias , Humanos , Pessoa de Meia-Idade , Idoso , Fasciite Necrosante/cirurgia , Pé Diabético/cirurgia , Estudos Retrospectivos , Fatores de Risco , Amputação Cirúrgica , Extremidade Inferior/cirurgiaRESUMO
Background: Vibrio vulnificus infections develop rapidly and have high mortality and disability rates. Vibrio vulnificus can cause local wound infection, gastroenteritis, or septicemia. Case Presentation: In this case, an 86-year-old male was accidentally stabbed in the middle of his right thumb while cleaning whitewater fish and came to the emergency department with high fever and painful swelling of the right hand. Physical examination revealed hemorrhagic bullae in the right hand. Emergency surgery and bacterial culture were performed. Because of timely antibiotic use and surgical treatment, the patient eventually recovered and was discharged from the hospital. Conclusions: This case suggests that the possibility of Vibrio vulnificus should be considered in cases of severe infection of the extremities, even without a history of seafood consumption or seawater exposure. Early recognition, rational choice of antibiotic agents, and timely wound debridement can substantially improve the prognosis of patients and reduce mortality.
Assuntos
Antibacterianos , Fasciite Necrosante , Sepse , Vibrioses , Vibrio vulnificus , Humanos , Fasciite Necrosante/microbiologia , Fasciite Necrosante/cirurgia , Masculino , Vibrio vulnificus/isolamento & purificação , Vibrioses/diagnóstico , Vibrioses/tratamento farmacológico , Vibrioses/microbiologia , Vibrioses/cirurgia , Idoso de 80 Anos ou mais , Sepse/microbiologia , Sepse/tratamento farmacológico , Antibacterianos/uso terapêutico , Dedos/cirurgia , Dedos/microbiologia , DesbridamentoRESUMO
INTRODUCTION: Infectious affections are the most frequent post-operative complications, the rate have been reducing due to the administration of perioperative antibiotics and they are rarely serious. They are usually associated to pelvic collections, fistulas, urinary tract stenosis and, exceptionally, necrotizing fasciitis (FN) and pelvic organ necrosis. There is no well-codified treatment. CASE PRESENTATION: A 42-year-old female patient, was referred to our department for a stage IIIC2 adenocarcinoma of the uterine cervix. Two months after surgery, the patient presented with fever. Abdominal CT scan revealed a recto-vaginal fistula. The patient underwent a surgical evacuation of the collection and a bypass colostomy. Post-operative period was marked by the occurrence of an extensive necrosis to pelvic organs and medial left leg's thigh compartments muscles. She also presented a thrombosis of the left external iliac vein and artery. Given the septic conditions, a revascularization procedure was not feasible. A bilateral ureterostomy was required and a ligature of the left external iliac vessels. Then she received palliative treatment.she died one month after surgery because of multivisceral failure due to sepsis. CONCLUSION: Necrotizing fasciitis is extremely rare and serious condition, the diagnosis is clinical and radiological, CT scan is helpful for the. There are predisposing factors such as diabetes, neoadjuvant radiotherapy or chemotherapy. The prognosis can be improved with rapid management and appropriate medical and surgical excisions of necrotic tissue, and antibiotic therapy adapted to the suspected germs, essentially anaerobic ones.
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Parede Abdominal , Fasciite Necrosante , Feminino , Humanos , Adulto , Fasciite Necrosante/cirurgia , Fasciite Necrosante/diagnóstico , Parede Abdominal/cirurgia , Prognóstico , Complicações Pós-Operatórias , Necrose/complicaçõesRESUMO
Necrotising fasciitis (NF) is an uncommon surgical emergency that threatens the life and health of patients. We report the treatment of a 76-year-old female patient with NF. The patient developed NF due to chronic poor glycaemic control, which further progressed to multiple organ dysfunction syndrome due to the severity of the hyperglycaemia. After resuscitation at the intensive care unit, surgical treatment was recommended and the patient underwent laparoscopic surgery. She had an uneventful post-operative recovery with aggressive anti-inflammatory therapy, glycaemic control and systemic nutritional support. There were no recurrences during the next 6 months of follow-up. NF should be diagnosed and treated as early as possible to gain valuable treatment time for the patient. Laparoscopic surgery is a treatment option.
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Fasciite Necrosante , Laparoscopia , Feminino , Humanos , Idoso , Fasciite Necrosante/cirurgia , Fasciite Necrosante/diagnóstico , Insuficiência de Múltiplos Órgãos/etiologia , DesbridamentoRESUMO
BACKGROUND: Necrotizing soft tissue infections (NSTIs) are associated with significant mortality if not promptly diagnosed and surgically treated. AIM: This study aims to compare patients with severe skin and soft tissue infection treated with or without a surgical intervention and to identify risk factors that can predict the need for early surgery. METHODS: Demographics, clinical, laboratory, Risk Indicator for Necrotizing Fasciitis (LRINEC) and imaging results were retrospectively collected. RESULTS: There were 91 non-NSTI (group 1), 26 NSTI who were operated (group 2) and eight suspected NSTI who were not operated (group 3). In the multivariate analysis, skin necrosis, tachycardia, CRP value and hyperglycemia were predictive for surgery. A performance analysis revealed AUC of 0.65 (95%CI: 0.52-0.78) as to the LRINEC score for the use of surgery. The AUC for a predictive model associating four variables (heart rate, skin necrosis, CRP and glycemia at admission) was 0.71 (95%CI: 0.59-0.84). In terms of outcome, the median length of stay (LOS) was statistically higher in group 2 vs. group 1 (seven days (5-15) vs. 34 days (20-42), p < .001) and in group 2 vs. group 3 (34 days (20-42) vs. 14 days (11-19), p = .005). The overall in-hospital mortality at 30 days was 3.2% and did not statistically differ between the three groups. CONCLUSIONS: Although the LRINEC score performed well in predicting surgery, the AUC of a model combining four predictive variables (glycemia, skin necrosis, CRP and heart rate) was superior. Further research is needed to validate this model.
Assuntos
Hospitais de Ensino , Infecções dos Tecidos Moles , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Infecções dos Tecidos Moles/mortalidade , Infecções dos Tecidos Moles/cirurgia , Idoso , Estudos Retrospectivos , Fatores de Risco , Bélgica/epidemiologia , Adulto , Fasciite Necrosante/cirurgia , Fasciite Necrosante/mortalidade , Idoso de 80 Anos ou mais , Tempo de InternaçãoRESUMO
BACKGROUND: NF is a life-threatening soft tissue infection that most commonly occurs in the lower extremity. While presenting symptoms such as erythema, severe pain, sepsis, and wound crepitation are well documented, diagnosis of NF of the breast often is obscured by a low clinical index of suspicion due to its relative rarity as well as by the breast parenchyma that physically separates the underlying fascia and overlying skin. Several risk factors have previously been identified, such as underlying infection, diabetes, advanced age, and immunosuppression. However, the gross morbidity and high mortality associated with NF warrant continued surveillance of contributing factors across any anatomic location. Fifteen cases in the literature document the development of NF following breast surgery. CASE REPORT: The authors of this case report aim to expand on the current literature through the presentation of a unique case of NF of the breast following right breast lumpectomy and oncoplastic closure with left reduction mammaplasty in an immunocompromised patient found to have concurrent perforated sigmoid diverticulitis. CONCLUSION: This case exemplifies how frequent postoperative surveillance, a low threshold for intervention, and efficient coordination of care are vital to minimizing the morbidity and mortality risks associated with NF of the breast.
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Fasciite Necrosante , Infecções dos Tecidos Moles , Feminino , Humanos , Fasciite Necrosante/etiologia , Fasciite Necrosante/cirurgia , Mastectomia Segmentar/efeitos adversos , Infecções dos Tecidos Moles/cirurgia , Fáscia , MastectomiaRESUMO
ABSTRACT: Background : Necrotizing soft-tissue infections (NSTIs) present a surgical emergency of increasing incidence, which is often misdiagnosed and associated with substantial mortality and morbidity. A retrospective multicenter (11 hospitals) cohort study was initiated to identify the early predictors of misdiagnosis, mortality, and morbidity (skin defect size and amputation). Methods : Patients of all ages who presented with symptoms and were admitted for acute treatment of NSTIs between January 2013 and December 2017 were included. Generalized estimating equation analysis was used to identify early predictors (available before or during the first debridement surgery), with a significance level of P < 0.05. Results : The median age of the cohort (N = 216) was 59.5 (interquartile range = 23.6) years, of which 138 patients (63.9%) were male. Necrotizing soft-tissue infections most frequently originated in the legs (31.0%) and anogenital area (30.5%). More than half of the patients (n = 114, 54.3%) were initially misdiagnosed. Thirty-day mortality was 22.9%. Amputation of an extremity was performed in 26 patients (12.5%). Misdiagnosis was more likely in patients with a higher Charlson Comorbidity Index (ß = 0.20, P = 0.001), and less likely when symptoms started in the anogenital area (ß = -1.20, P = 0.003). Besides the established risk factors for mortality (septic shock and age), misdiagnosis was identified as an independent predictor of 30-day mortality (ß = 1.03, P = 0.01). The strongest predictors of the final skin defect size were septic shock (ß = 2.88, P < 0.001) and a skin-sparing approach to debridement (ß = -1.79, P = 0.002). Conclusion : Recognition of the disease is essential for the survival of patients affected by NSTI, as is adequate treatment of septic shock. The application of a skin-sparing approach to surgical debridement may decrease morbidity.
Assuntos
Fasciite Necrosante , Choque Séptico , Infecções dos Tecidos Moles , Adulto , Feminino , Humanos , Masculino , Estudos de Coortes , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/cirurgia , Estudos Retrospectivos , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/cirurgia , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou maisRESUMO
BACKGROUND: Necrotising fasciitis is a rare and fulminant soft tissue infection. Prompt surgical debridement of the involved soft tissues and necrotic fascia is its definitive treatment, with any delay associated with increased mortality. The LRINEC score is a scoring system initially designed to aid in early diagnosis of necrotising fasciitis to facilitate early surgical intervention. This score utilizes common biochemical tests to produce a score of 0-13, stratifying patients into risk categories. METHODS: A prospective cohort study was designed including all patients presenting with severe soft tissue infection from June 2011 to January 2014. Exclusion criteria included: less than 15 years or above 90 years, antibiotics within 48 h of presentation or prior debridement of their soft tissue infection. All patients underwent routine blood investigations, required for calculation of the LRINEC score. RESULTS: The positive predictive value of the LRINEC score was 95.42%, whilst the negative predictive value was 81.16%. There was a statistically significant correlation between white cell count, serum creatinine, blood glucose level and positive histopathology. The mortality rate for patients with histopathologically-confirmed necrotising fasciitis was 10%. CONCLUSION: The LRINEC score is a clinical adjunct to risk stratify patients presenting to the emergency department with soft tissue infections. It utilizes common blood tests commonly to calculate a score, which risk stratifies patients. The use of this scoring system can facilitate better allocation of resources and aids in the decision to transfer patients in rural or regional settings, which are often complicated by being a resource limited environment.
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Fasciite Necrosante , Infecções dos Tecidos Moles , Humanos , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/cirurgia , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/cirurgia , Estudos Prospectivos , Região de Recursos Limitados , Estudos Retrospectivos , Fatores de RiscoRESUMO
ABSTRACT: Wound soaking is a physical debridement method that helps reduce bacterial colonization and consequently promotes wound healing. Although soaking in povidone-iodine solution was ineffective in reducing bacterial colonization in acute trauma wounds, there is still a lack of evidence supporting the efficacy of this method in treating severe soft tissue infection. This study aimed to explore the effects of wound soaking in 1% dilute povidone-iodine solution on necrotizing fasciitis caused by diabetic foot ulcers. We retrospectively reviewed and finally included 153 patients who were admitted because of diabetic foot ulcers after undergoing fasciotomy for necrotizing infection from January 2018 to December 2021. Results showed no statistical difference in the outcomes between patients in the soaking and nonsoaking groups. End-stage renal disease (P = 0.029) and high serum C-reactive protein level (P = 0.007) were the only independent factors for below-knee amputation in the univariate and multivariate logistic regression analyses. Therefore, soaking diabetic wounds with severe infection in 1% dilute povidone-iodine solution may not reduce the hospital length of stay, risk of below-knee amputation, and readmission rate.
Assuntos
Diabetes Mellitus , Pé Diabético , Fasciite Necrosante , Humanos , Povidona-Iodo/uso terapêutico , Pé Diabético/cirurgia , Fasciite Necrosante/cirurgia , Estudos Retrospectivos , CicatrizaçãoRESUMO
Objective: To evaluate the effectiveness of Kangfuxin Liquid (a traditional Chinese medicine) gauze and Vaseline gauze in wound healing after necrotizing fasciitis surgery. Method: The study was conducted at The First Affiliated Hospital of Baotou Medical College between February 2020 and February 2022. A total of 54 patients diagnosed with necrotizing fasciitis were randomly assigned to the Vaseline gauze group as the control group, and the Kangfuxin Liquid gauze group as the experimental group. Various aspects of treatment efficacy, wound healing conditions, healing indicators, pain scores, inflammation markers, and adverse reactions were compared between the two groups. Results: The total effective rate in the experimental group (100.00%) was significantly higher than that in the control group (77.78%), with a statistically significant difference The experimental group showed lower scores for secretion, granulation tissue morphology, redness, and swelling compared to the control group, with statistical significance. Additionally, the experimental group exhibited faster slough separation, new epidermis formation, and overall wound healing compared to the control group, with statistical significance. Visual analog scale (VAS) scores on postoperative days 3, 7, 9, and 14 were significantly lower in the experimental group than in the control group. Before treatment, there was no statistically significant difference in the levels of interleukin-17 (IL-17), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) between the two groups. However, after treatment, both groups exhibited a decrease in inflammatory markers, and the experimental group had significantly lower levels of IL-17, IL-6, and TNF-α compared to the control group). Furthermore, the incidence of adverse reactions in the experimental group (3.70%) was significantly lower than that in the control group (22.22%). Conclusion: The utilization of Kangfuxin Liquid gauze in wound healing after necrotizing fasciitis surgery effectively promotes wound healing, provides precise therapeutic effects, significantly reduces patient pain, improves inflammation, and exhibits minimal adverse reactions, thus demonstrating high safety. Therefore, the application of Kangfuxin Liquid gauze in this clinical context is highly recommended.
Assuntos
Medicamentos de Ervas Chinesas , Fasciite Necrosante , Vaselina , Cicatrização , Humanos , Cicatrização/efeitos dos fármacos , Masculino , Feminino , Pessoa de Meia-Idade , Fasciite Necrosante/tratamento farmacológico , Fasciite Necrosante/cirurgia , Medicamentos de Ervas Chinesas/uso terapêutico , Medicamentos de Ervas Chinesas/farmacologia , Adulto , Vaselina/uso terapêutico , Bandagens , Idoso , Materia MedicaRESUMO
Necrotising fasciitis (NF) is a life-threatening bacterial infection characterised by rapid tissue destruction, which can have severe consequences if not recognised early and treated promptly. It is most commonly caused by group A streptococcus entering the body through breaks in the skin. This case report describes a patient who presented with systemic signs of infection, including right axillary pain, following a recent intramuscular injection. Clinical examination and radiological findings were consistent with NF, and surgical exploration confirmed the diagnosis of thoracic NF. The patient underwent extensive surgical debridement, intensive care management and subsequent reconstructive surgery. This report highlights the importance of early recognition of NF and that this condition is not limited to the limbs but may also affect the torso. It employs consideration of all portals of potential bacterial entry that may prompt a differential of NF through thorough history taking. This case encourages healthcare professionals to maintain awareness of skin infections as a potential though rare complication of procedures such as injections hence the continued value of aseptic techniques to minimise risk. Finally, it emphasises that prompt diagnosis, appropriate antibiotic therapy and immediate surgical intervention remain crucial in managing NF and improving patient outcomes.
Assuntos
Fasciite Necrosante , Procedimentos de Cirurgia Plástica , Humanos , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/cirurgia , Desbridamento/métodos , Streptococcus pyogenes , Extremidades/cirurgia , Antibacterianos/uso terapêuticoRESUMO
A 60-year-old woman with a â¼450 cm 2 right cervicofacial defect following successful treatment of necrotizing fasciitis was consulted for reconstruction. She had complete orbital, malar, buccal, labial, submental, and anterolateral neck skin and soft tissue defects and near complete defects of the forehead and nasal sidewall. She underwent reconstruction with a large 24 cm×11 cm supraclavicular, deltopectoral, forehead rotational, and labial advancement flaps with skin grafting of the orbit. Follow-up at 2 months demonstrated complete take of all flaps. The patient was satisfied with her appearance and considered her outcome favorable. She exhibited comparably premorbid speech and oral competence. Large defects of the head and neck require thorough surgical planning and consideration of a subunit reconstruction technique. While free tissue transfer provides a large area of healthy tissue from a suitable donor site, subunit reconstruction with local and regional flaps can provide a superior outcome in the correct patient.
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Fasciite Necrosante , Procedimentos de Cirurgia Plástica , Humanos , Feminino , Pessoa de Meia-Idade , Fasciite Necrosante/cirurgia , Retalhos Cirúrgicos , Transplante de Pele , TestaRESUMO
Cervical necrotizing fasciitis (CNF) is a rare condition in the United States, with very few cases reported as a sequela of mandibular fracture. The authors describe the case of a 40-year-old man with poor oral health and no significant past medical history who developed CNF following delayed treatment of an open mandibular fracture, leading to life-threatening septic shock, thrombophlebitis of the internal jugular vein, and septic emboli to the lungs. Successful management of this patient was accomplished by serial surgical debridement, the administration of broad-spectrum antibiotics, and hemodynamic support. Eventual reconstruction was performed with external fixation of the mandible fracture and split-thickness skin grafting for the left neck and chest wound. The authors recommend early treatment of open mandibular fractures for immunocompromised patients or patients with poor oral hygiene to avoid the rare but potentially fatal complication of CNF and highlight external fixation as a useful technique in select cases of complex mandibular fractures.
Assuntos
Fasciite Necrosante , Fraturas Mandibulares , Masculino , Humanos , Adulto , Fraturas Mandibulares/diagnóstico por imagem , Fraturas Mandibulares/cirurgia , Fraturas Mandibulares/complicações , Fasciite Necrosante/etiologia , Fasciite Necrosante/cirurgia , Pescoço , Mandíbula , Tempo para o TratamentoRESUMO
Necrotizing fasciitis is a progressive and rare disease, with high potential to be life-threatening because of its potential for systemic toxicity. Characterized by fascial infection, it is often followed by systemic toxicity, such as septic shock and multi-organ failure. The aim of this study is to establish reliable data on the treatment of necrotizing fasciitis patients at the topmost referral hospital in West Java, Indonesia. We collected medical record data from January 2015 to December 2021 at Rumah Sakit Umum Pusat Dr. Hasan Sadikin (RSHS), Bandung, Indonesia. We recorded the infection region, bacterial isolates, empirical antibiotics, waiting time for the first surgery, surgical management, length of stay and we analysed the pattern of bacterial isolates, antibiotic use, waiting time for the first surgery, length of stay and mortality. A total of 90 patients' medical records were analysed. We found that the infection was most found in the genitalia and inguinal region (37%). Eighty-five percent of all samples containing gram-negative bacteria. The most used empirical antibiotics were from Cephalosporin class (31%), most of them combined with nitroimidazole (metronidazole) and with quinolones (levofloxacin, ciprofloxacin). Overall mortality rate was 13.3%. Highest mortality rate came from gram-negative bacteria group (14.2%-11 out of 77 patients), patients receiving Ceftriaxone-Metronidazole as empirical antibiotics (28.57%-4 out of 14 patients), patients with no surgery group (37%-3 out of 8 patients), with no mortality came from patients, which were performed debridement followed by fasciotomy/skin graft/flap and amputation. We conclude that the most found bacterial aetiology was Acinetobacter baumanii though it has no significant relation to mortality. We highly recommend early aggressive surgical intervention in reducing mortality rate due to necrotizing fasciitis for source control accompanied by deliberate defect closure and early administration of empirical antibiotics with more susceptibility for gram-negative bacteria, such as Meropenem.
Assuntos
Fasciite Necrosante , Humanos , Fasciite Necrosante/epidemiologia , Fasciite Necrosante/cirurgia , Indonésia/epidemiologia , Metronidazol , Resultado do Tratamento , Hospitais , Bactérias Gram-Negativas , Antibacterianos/uso terapêutico , Encaminhamento e Consulta , Desbridamento , Estudos RetrospectivosRESUMO
Odontogenic infections can rarely progress to necrotizing soft tissue infections. Cervical necrotizing fasciitis (CNF) is a rare but fulminant infection that spreads along the fascial planes, including connective tissue, muscle, and subcutaneous fat, and is typified by necrosis of the skin and other adjacent tissues. This article aims to present the treatment of a patient with submental skin and soft tissue necrosis due to an odontogenic infection and the subsequent management of the tissue deficit with a vacuum-assisted closure (VAC) system. The patient presented with extensive skin necrosis in the submental area and was immediately hospitalized, and management of the odontogenic infection was performed. When the patients' infection had been sufficiently controlled, a wound VAC device was placed in the deficit. The VAC device was removed after 12 days, and the patient was discharged. In conclusion, VAC can be used to manage tissue deficits with good aesthetic results.