Efficacy of Chinese and Western Medical Techniques in Treating Diabetic Foot Ulcers With Necrotizing Fasciitis of the Lower Leg.

To analyze and evaluate the clinical efficacy of Chinese and Western medical techniques in the treatment of severe diabetic foot ulcers complicated with necrotizing fasciitis of the lower leg and summarize the treatment experience of such patients to identify a new method of limb salvage treatment. A total of 46 patients with severe diabetic foot ulcers and necrotizing fasciitis of the lower leg were treated with such techniques as surgical debridement, bone drilling, open joint fusion, and microskin implantation. Wounds were treated with moisture-exposed burn therapy (a regenerative medical treatment for burns, wounds, and ulcers) and moisture-exposed burn ointment (a traditional Chinese medicine); underlying diseases were also treated effectively. The wound healing time, rate of high amputation, and mortality of these patients were summarized, and the clinical efficacy of such treatments was evaluated. Of the 46 patients enrolled, 38 patients were cured, with a cure rate of 82.61%. The average wound healing time was 130 ± 74.37 days. Two patients underwent high amputations, with an amputation rate of 4.35%, and 4 deaths occurred, with a mortality rate of 8.70%. The combination of Chinese and Western medical techniques in the treatment of severe diabetic foot ulcers complicated with necrotizing fasciitis of the lower leg not only effectively saved patients' lives and promoted wound healing but also greatly reduced the rates of high amputation and disability.

[Prevention of the after-eff ects of severe skin infections, reconstruction and rehabilitation]. / Prévention des séquelles des infections cutanées graves, reconstruction et réhabilitation.

PREVENTION OF THE AFTER-EFFECTS OF SEVERE SKIN INFECTIONS, RECONSTRUCTION AND REHABILITATION. The management of necrotizing bacterial dermohypodermatitis and necrotizing fasciitis is surgical. The procedure is often very disfiguring, with a significant loss of substance, responsible for important sequelae. Surgical techniques (skin grafts and flaps) can improve the functionality of a limb, but non-surgical tools can moreover accelerate the healing process such as negative pressure therapy, and maintain a good functionality through functional rehabilitation, massage, cryotherapy, thermotherapy or electrotherapy.

PRÉVENTION DES SÉQUELLES DES INFECTIONS CUTANÉES GRAVES, RECONSTRUCTION ET RÉHABILITATION. La prise en charge des dermohypodermites bactériennes nécrosantes-fasciites nécrosantes est chirurgicale. Le geste est souvent très délabrant, entraînant une perte de substance conséquente, responsable de séquelles importantes. Les techniques chirurgicales (greffes de peau et de lambeaux) peuvent améliorer la fonctionnalité d'un membre, mais des outils non chirurgicaux permettent par ailleurs d'accélérer le processus de cicatrisation, comme la thérapie par pression négative, et de conserver une bonne fonctionnalité grâce à la rééducation fonctionnelle, les massages, la cryothérapie, la thermothérapie ou l'électrothérapie.

Fascitis necrotizante. Presentación de un paciente / Necrotizing fascitis. Presentationof a patient

La fascitis necrotizante es una enfermedad infecciosa grave y poco frecuente de piel y partes blandas, asociada a una alta mortalidad. Generalmente es de etiología polimicrobiana, su manejo es difícil y representa un desafío para todo el personal de salud implicado en el tratamiento. Se presenta un paciente con ese diagnóstico atendido en el servicio de Cirugía General del Hospital General Docente Leopoldito Martínez, de San José de las Lajas, provincia Mayabeque, El mismo se presentó con un absceso perianal que evolucionó hacia una fascitis necrotizante afectando al escroto derecho, la región inguinal y toda la pared anterolateral del abdomen, evolucionando al shock séptico. En el paciente que se presenta, el diagnóstico fue clínico, la conducta terapéutica estuvo sustentada en el tratamiento quirúrgico, el uso de antimicrobianos sistémicos y del oleozón tópico. La evolución fue satisfactoria(AU)

Necrotizing fascitis is a critical and non-frequent infectious disease of the skin and soft tissues, associatedto a high mortality. Generallyit has a poli-microbial etiology, its management is difficult and it represents a challenge for all the health personnel involved in the treatment. A patient comes with that diagnosis assisted in General Surgery Service at LeopolditoMartínez General Teaching Hospital in San José de lasLajas, Mayabequeprovince, the patient went to the hospital complaining of a perianal abscess that developed to a necrotizing fascitis affecting the right scrotumin the inguinal site and all the anterolateral abdomen wall , developing asepticshock. In this patient it was a clinical diagnosisthe therapeutic management was a surgical treatment,the use of systemic antimicrobials and topicoleozon. The evolution was good(AU)

A rare late complication after concomitant chemoradiation of an oropharyngeal tumor: cervical necrotizing fasciitis.

Chemoradiation is increasingly being used to treat locally advanced head and neck carcinomas. Possible rare complications of this treatment modality have begun to appear, as the number of treated patients increase. In this report, we present a case who underwent chemoradiation due to T3N3M0 tonsil cancer and developed necrotizing fasciitis of the neck at seven months following treatment. The patient recovered fully after treatment with surgical debridement with pectoralis major flap reconstruction and intravenous antibiotherapy.

Necrotizing fasciitis of the lower limb after venous surgery: cases studies and a review of the literature.

We report 2 cases of necrotizing fasciitis following stripping of the long saphenous vein and phlebectomy of varicose collateral vessels. The first one concerns a 42-year-old man who presented with a left thigh postoperative infection, evolving despite oral antibiotic therapy. Urgent surgical exploration proved an extensive necrosis consistent with necrotizing fasciitis. Wide excision of the necrotic tissue was performed. Under intravenous antibiotic therapy, local wound care and hyperbaric oxygen therapy, the patient's condition improved. The second case concerns a 60-year-old man with cardio-vascular disease and diabetes. He was transferred in our institution 7 days after surgery for an infection in the right thigh and septic shock. Immediate surgical exploration showed extensive necrotizing fasciitis of the thigh, popliteal fossa and latero-posterior compartments of the leg. Muscle necrosis of the right leg was also observed. A right supra-condylar amputation was performed. The patient improved under antibiotherapy and hyperbaric oxygen therapy.

Fatal necrotizing fasciitis following two suicide attempts with petroleum oil injection.

PURPOSES: Necrotizing fasciitis is an aggressively progressing complication of the skin and soft tissue infections. It has dramatic course and often leads to patient's death. METHODS: In our research, we present the casuistic case concerning double suicide attempt with petroleum oil injection, complicated by the necrotizing fasciitis, patient was with deliberately withheld mental disorders. RESULTS: During the first suicide attempt, the oil substance was injected into the left cubital fossa and left toes areas, what lead to amputation of the upper left limb above the cubitial fossa and the left toes. Afterward, patient gradually recovered and survived. Two years later, another suicide attempt took place with the same substance: a 27-year-old man injected the petroleum oil into the right supraclavicular area. That affected a necrosis penetrating into the mediastinum and the patient died. CONCLUSIONS: To our knowledge, such case of the necrotizing fasciitis has not been previously reported. The mechanism of derivatives of oil influence on tissues is not investigated yet; therefore, treatment method is uncertain and sometimes ineffective.

Successful treatment of necrotizing fasciitis in the hind limb of a great dane.

A 5-month-old, intact female Great Dane was presented for an acute onset of rapidly progressive lameness, severe pain, and diffuse swelling of the right hind limb. Ultrasound evaluation revealed echogenic fluid pockets extending along fascial planes of the right hind limb, from the proximal femur to the hock. Necrotic soft tissues were debrided, and closed-suction drains were placed. No foreign material was identified at surgery. Fluid culture identified a beta-hemolytic Streptococcus sp., and affected fascial histopathology was consistent with necrotizing fasciitis. Postoperatively, the puppy was managed with intravenous broad-spectrum antibiotics, local infusions of amikacin, and daily physical rehabilitation. Oral pentoxifylline was administered to treat bronchopneumonia and streptococcal toxic shock syndrome that developed secondary to necrotizing fasciitis. To our knowledge, this is the first report of a successfully managed case of beta-hemolytic, streptococcal, necrotizing fasciitis successfully managed after a single surgical debridement in combination with systemic broad-spectrum antibiotics, local amikacin infusion, active closed-suction drainage, daily cytology, massage, and passive range-of-motion exercises to maintain limb function.

Cervical necrotizing fasciitis originating with a periapical infection.

BACKGROUND: Necrotizing fasciitis is a rapidly spreading, soft-tissue infection involving the subcutaneous tissues. Necrotizing fasciitis originating from a dental-related source is rare. Practitioners should be aware that this infection could occur in patients who are immunocompromised and in patients who are healthy. Practitioners must treat this disease aggressively with surgical debridement and intensive medical support. CASE DESCRIPTION: The authors present a case report of a man with poorly controlled diabetes mellitus in whom a periapical infection progressed into a maxillofacial space abscess and finally cervical necrotizing fasciitis (CNF). A delay in his initial visit to a dentist was evident. The authors observed a successful outcome in the patient after he underwent several wide surgical debridement procedures, hyperbaric oxygen therapy and a protracted, intensive hospital stay lasting 34 days. CONCLUSIONS: Dentists should suspect that a patient has CNF when maxillofacial cellulitis or an abscess does not respond to conventional therapy. Findings of spreading skin erythema, induration, purple discoloration and anesthesia suggest necrotizing fasciitis. Early computed tomography scans may reveal gas within the deep tissues of the neck, fascial plane involvement or both. CLINICAL IMPLICATIONS: CNF has high morbidity and mortality rates if rapid aggressive therapy is not pursued. Spread of this polymicrobial infection can lead to mediastinitis or cranial base involvement. Mortality is directly proportional to the time to intervention.

Treating necrotizing fasciitis with or without hyperbaric oxygen therapy.

There is not enough clinical data to support the benefit of adjuvant HBO2 therapy for necrotizing fasciitis (NF). We retrospectively reviewed our 67 NF cases to compare the outcomes of adjuvant HBO2 therapy versus non-HBO2 therapy. The overall outcome and morbidity criteria were compared between a group of 29 NF patients who received the adjuvant HBO2 and a group of the remaining 38 NF patients treated by only surgery and other standards of care. This study did not find any difference between the groups in average length of hospital stay, and their mortality. However, six (25%) of the non-HBO2 group patients required amputation of extremities compared to one of the HBO2 group (Fisher exact p = 0.09). Although the benefit of adjuvant HBO2 therapy remains controversial for NF, and the outcomes of this study are not statistically significant, there is a trend in clinical outcomes which shows that the therapy has the potential to reduce the number of amputation and salvage extremities. These findings necessitate multicenter, prospective, case control study to assess the possible benefit of adjuvant HBO2 therapy for NF.

Surviving life-threatening illness: keys to optimal nursing care.

Necrotizing fasciitis (NF) is a rare yet life-altering infection. Disfigurement and death ensue without accurate diagnosis and treatment. Educational awareness can assist nurses to advocate for differential diagnosis, immediate treatment, and plan of care. This article examines the experience of a mother with NF, application of Neuman's Systems Model (NSM) to address her healing needs, and nursing practice guided by one's personal worldview. NSM was chosen because it is holistic and concise and can be utilized from a Christian perspective.

[Necrotizing fasciitis after "banal" back pain. An unusual course of a retrocoecal appendicitis and its sequellae]. / "Banale" Rückenschmerzen als erstes Symptom einer nekrotisierenden Fasziitis : Ungewöhnlich verlaufende retrozökale Appendizitis und ihre Folgen.

Necrotizing fasciitis is a life-threatening disease which can only be successfully treated by an interdisciplinary team. An immediate and radical debridement with opening of all compartments and debridement of the affected fascia is the basis for a successful therapy. We report about the treatment of a 21-year-old man who was taken to hospital due to "banal" back pain which was caused by a perforated appendicitis. In only 2 days necrotizing fasciitis developed which spread out over the complete right leg.

[A very extensive necrotizing fasciitis]. / Une fasciite nécrosante très extensive.

Necrotizing fasciitis is a severe skin infection. Fluidized bed may be indicated to improve healing. We report a 36-year-old woman case, who developed an important skin emphysema on a fluidized bed that may have worsen the situation.

[Complicated skin and soft tissue infections]. / Komplizierte Haut- und Weichgewebsinfektionen.

Skin and soft tissue infections are common diseases. The spectrum ranges from slight furuncles to severe necrotizing soft tissue infections. Grampositive bacteria account for 70-80 % of cases as causative organisms. Diagnostics include rapid evaluation of locally limited or diffuse spreading extent of the disease. In complicated skin and soft tissue infections, surgical intervention with debridement and necronectomy is indicated. Necrotizing skin and soft tissue infections call for programmed redebridement. If systemic signs of inflammation are present (fever > 38 degrees C, leukocytosis, CRP elevation) or significant comorbidity exists, application of antibiotics is indicated. The prognosis in operatively treated patients is dependent on the time of surgical intervention.

Necrotising fasciitis and traditional medical therapy-- a dangerous liaison.

INTRODUCTION: Necrotising fasciitis is a disease associated with high morbidity and mortality, and multi-focal necrotising fasciitis is uncommon. We present 2 cases of concurrent necrotising fasciitis of contralateral upper and lower limbs. CLINICAL PICTURE: Both presented with pain, swelling, bruising or necrosis of the affected extremities. Traditional medical therapy was sought prior to their presentation. TREATMENT: After initial debridement, one patient subsequently underwent amputation of the contralateral forearm and leg. The other underwent a forearm amputation, but refused a below-knee amputation. OUTCOME: The first patient survived, while the second died. CONCLUSION: Traditional medical therapy can cause bacterial inoculation, leading to necrotising fasciitis, and also leads to delay in appropriate treatment. Radical surgery is needed to optimise patient survival.