Risk Factors and Predictors of Outcome for Necrotising Fasciitis

Background:Necrotising fasciitis(NF) is one of the most fulminant infec?on of skin and so? ?ssue. It is a fatal rapidly progressing disease causing Mul? organ Dysfunc?on syndrome (MODS), sep?c shock & death if not iden?fied early & treated accordingly. The aim is to study risk factors associated with NF and predictors of outcome. Se?ngs & design: Prospec?ve observa?onal study in a single ter?ary care center. Materials and Methods:Prospec?ve analysis of pa?ents with NF from March 2018 – August 2019 was done. The known risk factors were studied. Results: A Total 120 pa?ents were reviewed. Out of which 81 (67.5%) were males and 39 (32.5%) were females. The mortality rate in our study was 14.16%. It was significantly high in pa?ents with CRF (p 0.045), HIV (p <0.001), Diabetes with other risk factors (p 0.003),BSA > 10% (p <0.01), Type 3 culture (0.027),LRINEC score >6 (p 0.015). Conclusion:NF in pa?ents with known risk factors progresses rapidly, so aggressive treatment should be given at the earliest. Early iden?fica?on & prompt interven?on is the key for be?er survival outcome in NF.

Anaesthetic Management of a Case of Necrotising Fascitis with Uncorrected Tetralogy of Fallot with Scoliosis Posted for Debridement

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease, characterized by aortic overriding, right ventricular hypertrophy, pulmonary stenosis (PS) and ventricular septal defect (VSD). When left untreated, survival to adulthood is rare. There are few case reports of uncorrected TOF surviving to adulthood and then presenting for noncardiac surgeries. We present a case of debridement of a necrotizing fasciitis under low dose spinal anaesthesia, in a patient of uncorrected TOF with scoliosis and cushingoid features.

Hemivulvectomía radical por gangrena de fournier en mujer con antecedente de radioterapia pélvica / Radical hemivulvectomy due to Fournier's gangrene in a woman with a history of pelvic radiotherapy

RESUMEN La Gangrena de Fournier es una infección necrotizante que afecta al área genitourinaria, perineal y perianal. Se trata de una infección muy grave con una rápida evolución a estadios avanzados y una elevada tasa de morbimortalidad asociada. Sin embargo, con frecuencia tiende a ser infradiagnosticada. Es vital en su manejo un diagnóstico basado en la sospecha clínica e inicio del tratamiento quirúrgico precoz con desbridamiento y exéresis de los tejidos afectos. Además, es crucial la asociación de antibioterapia de amplio espectro y el apoyo nutricional de soporte en el pronóstico de dicha entidad. En este artículo se revisa un caso clínico de Gangrena de Fournier, en una paciente con antecedentes de osteítis púbica y cistitis derivadas del tratamiento mediante radioterapia pélvica, diagnosticado y tratado con una hemivulvectomía radical, antibioterapia y lavados quirúrgicos en nuestro Hospital.

ABSTRACT The Fournier's Gangrene is a necrotizing infection which is located in the perineal area. It´s a severe infection, which involves a quick evolution to advanced stages where a high morbimortality rate is associated. However, it often tends to be underdiagnosed in early stages. The most important in the diagnosis is a high clinical suspicion and subsequent surgical treatment which is base on a desbridalment and exeresis of the affected tissues. In addition, the association of broad-spectrum antibiotic therapy and nutritional support are crucial. This report reviews a clinical case of Fournier's Gangrene, in a patient with a history of radiation induced cystitis and pubic osteitis after pelvic radiotherapy, diagnosed and treated with a radical hemivulvectomy, antibiotic therapy and lavages in our Hospital.

Fascitis necrotizante tipo II como urgencia dermatológica en un recién nacido / Type II necrotizing fasciitis as a dermatological emergency in a newborn

Introducción: la fascitis necrotizante es una infección rápidamente progresiva de la piel y de los tejidos blandos, que suele asociarse con una importante toxicidad sistémica. Es considerada una urgencia dermatológica. Caso clínico: se presenta el caso clínico de un recién nacido sin antecedentes perinatales patológicos que con 12 días de vida; ingresó en cuidados especiales neonatales por una infección grave de partes blandas en la región torácica que evolucionó al shock. La clínica, hemoquímica y la microbiología confirmaron el diagnóstico de una fascitis necrotizante. En su evolución requirió una valoración multidisciplinaria e inmediato tratamiento quirúrgico agresivo por caumatología; que consistió en la resección, con desbridamiento amplio y completo de todos los tejidos necróticos. Al mes de vida, se decidió realizar un injerto libre de piel que se extrajo de la propia madre (injerto homólogo). Fue egresado después de 3 meses de estancia hospitalaria con una recuperación completa y sin evidencia de daños orgánicos. Conclusiones: la fascitis necrotizante en el recién nacido es considerada una urgencia dermatológica inusual.

Introduction: necrotizing fasciitis is a rapidly progressive infection of the skin and soft tissues, often associated with a significant systemic toxicity. It is considered a dermatological emergency. Clinical case: the case of a newborn with 12 days of life and with no pathological perinatal history is presented; admitted for special neonatal cares service due to a severe soft tissue infection in the thoracic region that evolved to shock. Clinical, microbiology and chemistry testing confirmed the diagnosis of a necrotizing fasciitis. In its evolution, it was required a multidisciplinary and immediate aggressive surgical treatment by burnt specialists; which consisted of resection, with broad and complete removal of all necrotic tissue. After one month of life, we decided to perform a free skin graft taken from the mother herself (homologous graft). The patient was discharged from hospital after 3 months, with a full recovery and no evidence of organ damage. Conclusions: newborn necrotizing fasciitis is considered an unusual dermatological emergency.

Infección necrosante de tejidos blandos y neoplasia gastrointestinal / Necrotizing soft tissue infection and gastrointestinal malignancy

Las infecciones necrosantes de tejidos blandos presentan altas tasas de mortalidad. Estas se han relacionado con diferentes causas, incluidas las enfermedades neoplásicas. En la literatura se ha descrito infección necrosante especialmente en pacientes con neoplasias del tracto gastrointestinal bajo. La presentación de este caso clínico tiene como objetivo recordar a los médicos de urgencias la pertinencia de considerar este diagnóstico en pacientes con neoplasias de colon y recto en estadio avanzado y presentar una breve revisión de la literatura.

Necrotizing soft tissue infections have high mortality rates. These infections have been linked to various causes, including those related to neoplastic diseases. The literature has described necrotizing particularly in patients with malignancies of the colon and rectum. The presentation of this case is intended to remind emergency physicians to consider this diagnosis in patients with advanced-stage gastrointestinal tract tumors and to present a brief review of the literature.

Gangrena de Fournier / Fournier's gangrene

Introducción: la gangrena de Fournier es una enfermedad rara y grave, caracterizada por fasciitis necrotizante, sinergística y polimicrobiana, que mantiene alta mortalidad. Objetivo: contribuir a un mayor conocimiento del diagnóstico, tratamiento y pronóstico individual de esta rara enfermedad. Métodos: fueron estudiados siete pacientes tratados entre febrero de 2010 y abril de 2011. Se evaluaron datos demográficos, enfermedades asociadas, etiología, tratamiento, complicaciones y mortalidad, así como tiempo con sonda y estadía hospitalaria. Resultados: Los pacientes fueron hombres con edad media de 43,3 años; el más joven tenía 30 años y el mayor 49. Enfermedades asociadas: síndrome de inmuno deficiencia adquirida (2), diabetes mellitus (1), hipertensión arterial (1). El origen perineal (4) y escrotal (3). Tres pacientes referían fístulas o abscesos perineales. El tiempo de evolución fluctuó entre 6 y 30 días. Las manifestaciones clínicas se caracterizaron por dolor, aumento de volumen en regiones perineal, escrotal o ambas y secreción fétida. Se encontró crepitación cuando la enfermedad invadió regiones inguinales y pared abdominal. El tratamiento quirúrgico comprendió desbridamiento y derivaciones digestivas (colostomía), urológicas (cistotomía) o ambas. El número de intervenciones varió entre tres y siete. Se practicó la reconstrucción quirúrgica del periné y escroto con el uso de injertos de piel a los sobrevivientes. Tres enfermos (42,9 porciento) tuvieron complicaciones: shock séptico, fallo orgánico múltiple y estenosis uretral tardía (1). Falleció un enfermo (14,3 porciento), que había ingresado con manifestaciones de shock séptico. Conclusiones: El éxito del tratamiento se logra con el diagnóstico temprano, desbridamiento quirúrgico precoz, agresivo y antibioticoterapia de amplio espectro(AU)

Introduction: Fournier's gangrene is a rare and serious disease, which is characterized by necrotizing, synergistic and polymicrobial fasciitis and maintains high mortality. Objective: to contribute to a better knowledge about the individual diagnosis, treatment and prognosis of this rare disease. Methods: Seven patients who were treated from February 2010 to April 2011 were studied. Demographic data, associated diseases, etiology, treatment, complications and mortality were evaluated as well as the time with probe and hospital stay. Results: the patients were men with a mean age of 43, 3 years; the youngest was 30 years old and the oldest was 49. The associated diseases were: acquired immunodeficiency syndrome (2), diabetes mellitus (1), and hypertension (1). The origins were perineal (4) and scrotal (3). Three patients reported to have perineal fistulas or abscesses. The time of evolution fluctuated between 6 and 30 days. Clinical manifestations were characterized by pain, increase in volume in perineal or scrotal regions or both and fetid secretion. Crepitation was found when the disease occupied the inguinal regions and the abdominal wall. Surgical treatment required debridement and digestive derivations (colostomy), urinary derivations (cytostomy) or both. The number of interventions varied between three and seven. Surgical reconstruction of the perineum and scrotum was practiced, using skin grafts in the survivors. Three patients (42.9 percent) presented complications: septic shock, multiple organ failure and late urethral stricture (1). A patient who had been admitted with manifestations of septic shock died (14.3 percent). Conclusions: the success of the treatment is achieved with the early diagnosis, early aggressive surgical debridement, and broad-spectrum antibiotic therapy(AU)

Necrotising Fascitis of the Thigh through Short External Rotator Muscles Due to an Unrecognized Perforated Rectal Cancer / 대한고관절학회지

Necrotizing fasciitis is one of the few true emergencies in orthopedic surgery that has a very high mortality rate unless recognized promptly and treated aggressively. The authors report a case of a patient with necrotizing fasciitis on the thigh that developed secondary to an unrecognized rectal cancer perforation through the short external rotator muscles. Clinicians should always be alert to the potential that rectal cancer perforations can cause necrotizing fasciitis in rare cases.

Two Cases of Necrotizing Fasciitis in Patients with SLE

Necrotizing fasciitis (NF) is an uncommon, life-threatening infection of the subcutaneous tissue and superficial fascia. The clinical course of NF is rapid and progressive, and it is often fatal despite the appropriate therapy. The prognosis of NF depends on a timely diagnosis and then proper treatment. At onset it may not be possible to clearly distinguish NF from minor soft-tissue infections. Although infection are common due to the use of steroids and immunosuppressive agents in patients with systemic lupus erythematous (SLE), it is interesting that NF has rarely been reported with SLE. Here, we present two cases of NF with SLE.

Gangrena de Fournier en asociación con el uso de anti-inflamatorios no esteroideos: Reporte de un caso pediátrico / An unusual presentation of Fournier's gangrene: ¿Is there a relationship with NSAID use? Pediatric case report

La gangrena de Fournier es una enfermedad amenazante para la vida, que se caracteriza por fascitis necrosante del área perineal. Afecta con mayor frecuencia a pacientes adultos con inmunosupresión y son pocos los casos reportados en la población pediátrica. El uso de fármacos anti-inflamatorios no esteroideos (AINEs) se ha asociado con fascitis necrosante, probablemente por supresión de la inmunidad durante la infección. Describimos el caso de un paciente con 6 meses de edad sin factores inmu-nosupresores, con gangrena de Fournier, probablemente asociada a la ingesta de AINEs.

Founier's gangrene is a rare but life-threatening disease characterized by necrotizing fasciitis of the perineal area. It mostly affects adult patients with an immunosuppressant factor and there are only a few cases reported in children. Use of nonsteroidal anti-inflammatory drugs has been associated with necrotizing fasciitis probably because of suppressing host immunity during infection. We describe a case of a six month old infant without im-munosuppressant factors, with Founier´s gangrene probably associated with nonsteroidal anti-inflammatory intake.

Gangrena de Fournier / Fournier’s gangrene

La Gangrena de Fournier es una enfermedad infecciosa caracterizada por una fascitis necrotizante de evolución fulminante que afecta a la región perineal, genital o perianal, presentando una rápida progresión y alta letalidad, siendo la etiología identificable en un 95 por ciento de los casos. La enfermedad ha sido descrita en ambos géneros, con edad promedio de presentación de 40 años y una mayor prevalencia en hombres, con una relación 10:1. La variedad de manifestaciones clínicas dificulta el diagnóstico, el que es fundamentalmente clínico. El tratamiento debe ser oportuno y agresivo, contemplando tres pilares fundamentales: manejo hidroelectrolítico y nutricional, antiobioterapia de amplio espectro y desbridamiento quirúrgico amplio. En este artículo presentamos una revisión sistemática actualizada de la literatura acerca de esta interesante entidad patológica, con especial énfasis en la epidemiología, etiología, presentación clínica, diagnóstico y tratamiento.

Application of BMS(TM) Avoids a Defunctioning Colostomy in the Treatment of Fournier's Gangrene

PURPOSE: Recently developed BMS(TM) (Zassi Bowel Management System(TM): Hollister Inc., Illinois, USA) can provide effective nonsurgical fecal diversion without the risks associated with colostomy creation and subsequent closure. Our aim is to evaluate the effectiveness of the BMS in diverting feces from the perianal wide surgical wound in patients with Fournier's gangrene. METHODS: BMS(TM) was applied in five patients (male: 2, median age; 44) with Fournier's gangrene from January 2000 to September 2001. The treatments consist of three times a day wound dressing after wide surgical debridement and intravenous antibiotic therapy. For evacuation of feces, twice daily warm saline irrigation was administered via BMS(TM) or low daily doses of polyethylene glycol solutions were orally taken in. An endoscopic and anorectal manometric study was done to evaluate possible mucosal complications and anorectal functional changes. RESULTS: The average duration of the BMS application was 41 (range, 22~63) days. The result of a manometric study after immediate removal of the BMS(TM) showed a decreased mean resting pressure (range: 22~36 mmHg) and a decreased mean squeezing pressure (range: 32~39 mmHg). After 3 days, the sphincter pressure had improved markedly: mean resting pressures of 38, 45, 60, and 63 mmHg and mean squeezing pressure of 78, 89, 91, and 101 mmHg respectively. Fecal incontience was not noted in any patient. Other possible mucosal complications were not noted. There were no mortalit. CONCLUSIONS: BMS(TM) application in Fournier's gangrene patients after surgery successfully avoids a defunctioning colostomy. Furthermore, no significant complications were noted over a prolonged period up to 63 days.

Gangrena de Fournier / Fournier’s gangrene

Catalogada como urgencia urológica, la gangrena de fournier es una enfermedad infecciosa de los genitales y del periné, rápidamente progresiva, que aparece a cualquier edad en hombres y aun en mujeres. Fournier en 1884 describió cinco casos de fascitis necrosante de genitales externos por causa desconocida; a la fecha se reconocen diversos factores etiológicos como lesión o infección del tracto genitourinario, focos infecciosos anorrectales, diabetes mellitus, inmunosupresion, HIV positivo. El proceso fisiopatológico consiste en la diseminación bacteriana linfática o hematógena o por contigüidad celular, que produce edema y disminución del aporte de oxígeno, infección linfática, venenosa y trombosis, estableciendo un medio propicio para la proliferación bacteriana y la destrucción tisular. Se produce enfisema tisular por infiltrado de gas cuando los agentes causantes son anaerobios, sobreviniendo la toxemia. Por todas estas razones es que la importancia radica en la rápida acción del médico cirujano de la aplicación de las medidas necesarias para salvar la vida del paciente.

Classified as a medical urgency, fournier’s gangrene is a rapidly progressive bacterial infection of the skin that affects the genitals and perineum common in men and women of any age. Fournier in 1884 discovered five cases of necrotizing fasciitis of genitals for unknown cause. Now it is known that there are a number of risk factors such as infection of genitourinary tract, anorectal infection, diabetes mellitus, immune system disorders and HIV positive.Lymphatic and hematogenous dissemination of the bacteria causes edema, lymphatic, venous and thrombotic infection caused by bacterial proliferation and tissue destruction. There will also be subcutaneous emphysema because the air gets into the tissues when the causative agents are anaerobics . Due to all these reasons it is important surgical intervention to save the life of the patient.

Escabiosis nodular impetiginizada, complicada con una fascitis necrotizante / Nodular sarcoptic mange, impetiginized complicated with a necrotizing fascitis

Se trata de una lactante de sexo femenino proveniente de la provincia de El Oro, que presenta un cuadro de escabiosis, caracterizado por lesiones lineales, papulares, impetiginizadas que asientan sobre una base eritematosa, acompañadas de prurito; consecuencia del rascado intenso, desarrolla una fascitis necrotizante que abarca la región lateral derecha de la cadera con gran pérdida de sustancia.

It is the case of a female breast fed child who is from El Oro (a coastal province), showing a clinical picture of sarcoptic infection, characterized by lineal, papular, impetiginized wounds, located over an erithematous base, accompanied by itch, resulting from intense scratching, developes a necrotizing fascitis that includes the right lateral region of the hip with great loss of substance.

Fournier's Gangrene: Clinical Analysis of 11 Patients

PURPOSE: Fournier's gangrene is a rare and rapidly progressive infection of the genitalia, perineum, and abdominal wall. The mortality rate from this infection ranges from 0 to 67 percent. One of the most important determinants of the overall outcome is early recognition and extensive surgical debridement combined with broad-spectrum antibiotics therapy. The objective of this study was to review the clinical outcomes of 11 consecutive patients who suffered with Fournier's gangrene and the related medical literature to highlight the current status of this disease. METHODS: We retrospectively reviewed the records of 11 patients with the Fournier's gangrene who had been treated at Gyeongsang National University Hospital between March 1995 and March 2005. RESULTS: The mean age was 60 years (range: 38~82), and the male to female ratio was 8 : 3. The most common cause of Fournier's gangrene was perianal abscess (n=4, 36.3%) and the most common disease associated with Fournier's gangrene was diabetes mellitus (n=6, 54.5%). The most common cultured organisms were E. coli and K. pneumoniae. We performed aggressive surgical debridement combined with broad spectrum antibiotics therapy. The number of surgical procedures per patients ranged between 1 and 7 (mean: 2.63). Diverting colostomy was required in 36.3% (n=4) of the cases. Two cases received reconstructive plastic surgery. The mortality rate of 11 patients was 27.2% (n=3) and the cause of death was sepsis. CONCLUSION: Fournier's gangrene is a life-threatening disease, but the mortality rate can be diminished via early diagnosis, aggressive surgical intervention, and the use of broad- spectrum antibiotics.

A case of Necrotizing Fascitis after Cesarean Section / 대한산부인과학회잡지

The necrotizing fascitis, that develops after a Cesarean section, is acknowledged as a rare complication due to the development of antibiotics. Having a very high mortality rate, the only way to prevent the septic shock and the impairment of the cardiopulomary function is the use of adequate antibiotics, the infusion of IV fluids, a radical section of the necrotized fascia and a through cleansing. We have an experience in treating a primipara who had a necrotic fascitis after Cesarean section, and therefore, report this case with the review of articles enclosed.

Acute necrotizing fascitis of the male genitalia (Fournire's gangrene) / 대한비뇨기과학회지

We reviewed 15 cases of necrotizing fascitis of the male genitalia. The clinical courses could be divided into two different types. In about one half of the patients the symptoms and signs progressed slowly within 122 weeks and in the remained they progressed rapidly. In the former, the prodromal signs were noted, usually low abdominal and inguinal pain. In 8 of fifteen patients, the locations of infectious focus were difficult to determine. The diagnosis were made after the development of scrotal necrosis in all of the cases. There were no differences in the causative pathogens comparing to 1hose of previous reports. The common underlying diseases were liver cirrhosis and diabetes. Hypoalbuminemia and leukocytosis were found in all. Of course, the strategy of treatment is same between two types, we would like to propose to use the term Fourier`s gangrene, a specific form of necrotizing fascitis, only to whose clinical course in acute and the location of primary infecious foci are obscure.

Acute necrotizing fascitis of the male genitalia (Fournire's gangrene) / 대한비뇨기과학회지

We reviewed 15 cases of necrotizing fascitis of the male genitalia. The clinical courses could be divided into two different types. In about one half of the patients the symptoms and signs progressed slowly within 122 weeks and in the remained they progressed rapidly. In the former, the prodromal signs were noted, usually low abdominal and inguinal pain. In 8 of fifteen patients, the locations of infectious focus were difficult to determine. The diagnosis were made after the development of scrotal necrosis in all of the cases. There were no differences in the causative pathogens comparing to 1hose of previous reports. The common underlying diseases were liver cirrhosis and diabetes. Hypoalbuminemia and leukocytosis were found in all. Of course, the strategy of treatment is same between two types, we would like to propose to use the term Fourier`s gangrene, a specific form of necrotizing fascitis, only to whose clinical course in acute and the location of primary infecious foci are obscure.