ABSTRACT
BACKGROUND: Mycoplasma hominis is typically found on the mucosal epithelium of the human genital tract, with infections being rare. However, when the mucosal barrier is compromised or in individuals with weakened immune systems, this microorganism can trigger infections in both intragenital and extragenital sites. This study offers a comprehensive overview of infections caused by the rare pathogen M. hominis. This overview helps laboratories identify M. hominis infections in a timely manner, thereby enabling earlier clinical intervention for patients. CASE PRESENTATION: A 75-year-old Taiwanese man with type 2 diabetes mellitus initially underwent a left lower extremity amputation following a severe infection caused by necrotizing fasciitis. Subsequently, a poorly healing wound developed at the site of amputation. Upon culturing the wound abscess, M. hominis was isolated and identified as the causative agent. CONCLUSIONS: Through this case, we present clinical and microbiological observations along with a review of the literature to deepen our understanding of M. hominis. Our findings can be used to develop laboratory diagnostic protocols and innovative therapeutic approaches.
Subject(s)
Amputation, Surgical , Diabetes Mellitus, Type 2 , Mycoplasma Infections , Mycoplasma hominis , Humans , Male , Aged , Mycoplasma hominis/isolation & purification , Mycoplasma Infections/diagnosis , Mycoplasma Infections/complications , Diabetes Mellitus, Type 2/complications , Anti-Bacterial Agents/therapeutic use , Fasciitis, Necrotizing/microbiology , Fasciitis, Necrotizing/surgery , Fasciitis, Necrotizing/diagnosis , LegABSTRACT
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.
Subject(s)
Drainage , Fournier Gangrene , Humans , Fournier Gangrene/surgery , Drainage/methods , Male , Treatment Outcome , Middle Aged , Fasciitis, Necrotizing/surgery , Female , Adult , Debridement/methods , Skin , Abscess/surgeryABSTRACT
<b><br>Introduction:</b> Necrotizing fasciitis (NF) is an expeditiously escalating inflammatory infection of the fascia, with secondary necrosis of the subcutaneous tissues. To aid diagnosis, the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scoring system was devised to stratify the likelihood of infection in patients on presentation.</br> <b><br>Aim:</b> The study aimed to investigate and quantify the relationships between the LRINEC scoring system and the outcomes such as the need for amputation, length of hospital stay, and mortality in patients with necrotizing fasciitis.</br> <b><br>Material and methods:</b> A total number of 90 patients were admitted with a provisional diagnosis of necrotizing fasciitis. LRINEC score was calculated for each case based on six laboratory variables at the time of presentation. Enrolled patients were divided into three groups on the basis of the LRINEC score. The differences in mortality, length of hospitalization, number of debridement procedures, and need for amputation between these groups were compared.</br> <b><br>Results:</b> Increasing age, male gender, and DM have a poor prognosis in necrotizing fasciitis patients. The amputation and mortality rates are better correlated with higher LRINEC scores.</br> <b><br>Conclusions:</b> The LRINEC score helps in stratifying the patients into three risk categories (low risk, moderate risk, and high risk) according to the severity in a much more organized way, and thus the appropriate management like surgical debridement can be introduced on time. LRINEC score is a robust index that is capable of detecting early cases of necrotizing fasciitis and is simple enough for routine use. It is a simplified bedside diagnostic tool for early diagnosis and prediction of outcomes in patients with necrotizing fasciitis.</br>.
Subject(s)
Fasciitis, Necrotizing , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/surgery , Fasciitis, Necrotizing/therapy , Humans , Male , Female , Middle Aged , Adult , Aged , Debridement/methods , Severity of Illness Index , Length of Stay/statistics & numerical data , PrognosisABSTRACT
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.
Subject(s)
Anti-Bacterial Agents , Fasciitis, Necrotizing , Hospital Mortality , Humans , Fasciitis, Necrotizing/mortality , Fasciitis, Necrotizing/surgery , Fasciitis, Necrotizing/microbiology , Male , Female , Retrospective Studies , Middle Aged , Aged , Anti-Bacterial Agents/therapeutic use , Hong Kong/epidemiology , Community-Acquired Infections/mortality , Community-Acquired Infections/surgery , Community-Acquired Infections/microbiology , Time-to-Treatment , Extremities/surgery , Extremities/pathology , Adult , Intensive Care Units/statistics & numerical data , Aged, 80 and overABSTRACT
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.
Subject(s)
Fasciitis, Necrotizing , Intestinal Perforation , Rectal Neoplasms , Thigh , Humans , Fasciitis, Necrotizing/etiology , Fasciitis, Necrotizing/surgery , Rectal Neoplasms/surgery , Rectal Neoplasms/complications , Intestinal Perforation/etiology , Intestinal Perforation/surgery , Male , Debridement , Adenocarcinoma/complications , Adenocarcinoma/surgery , Middle Aged , Sciatic Nerve/injuries , Pelvic Infection/etiologyABSTRACT
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.
Subject(s)
Anti-Bacterial Agents , Fasciitis, Necrotizing , Upper Extremity , Humans , Male , Fasciitis, Necrotizing/microbiology , Fasciitis, Necrotizing/therapy , Fasciitis, Necrotizing/surgery , Middle Aged , Female , Retrospective Studies , Aged , Upper Extremity/surgery , Upper Extremity/microbiology , Adult , Anti-Bacterial Agents/therapeutic use , Debridement , Soft Tissue Infections/microbiology , Soft Tissue Infections/therapy , Aged, 80 and over , Streptococcal Infections/microbiology , Streptococcal Infections/therapyABSTRACT
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.
Subject(s)
Anti-Bacterial Agents , Fasciitis, Necrotizing , Sepsis , Vibrio Infections , Vibrio vulnificus , Humans , Fasciitis, Necrotizing/microbiology , Fasciitis, Necrotizing/surgery , Male , Vibrio vulnificus/isolation & purification , Vibrio Infections/diagnosis , Vibrio Infections/drug therapy , Vibrio Infections/microbiology , Vibrio Infections/surgery , Aged, 80 and over , Sepsis/microbiology , Sepsis/drug therapy , Anti-Bacterial Agents/therapeutic use , Fingers/surgery , Fingers/microbiology , DebridementABSTRACT
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.
Subject(s)
Abdominal Wall , Fasciitis, Necrotizing , Female , Humans , Adult , Fasciitis, Necrotizing/surgery , Fasciitis, Necrotizing/diagnosis , Abdominal Wall/surgery , Prognosis , Postoperative Complications , Necrosis/complicationsABSTRACT
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.
Subject(s)
Diabetes Mellitus , Diabetic Foot , Fasciitis, Necrotizing , Skin Diseases , Humans , Middle Aged , Aged , Fasciitis, Necrotizing/surgery , Diabetic Foot/surgery , Retrospective Studies , Risk Factors , Amputation, Surgical , Lower Extremity/surgeryABSTRACT
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.
Subject(s)
Hospitals, Teaching , Soft Tissue Infections , Humans , Male , Female , Middle Aged , Soft Tissue Infections/mortality , Soft Tissue Infections/surgery , Aged , Retrospective Studies , Risk Factors , Belgium/epidemiology , Adult , Fasciitis, Necrotizing/surgery , Fasciitis, Necrotizing/mortality , Aged, 80 and over , Length of StaySubject(s)
Humans , Male , Infant , Fasciitis, Necrotizing/diagnosis , Streptococcal Infections , Shock, Septic , Multiple Organ Failure , Treatment Outcome , Inpatients , Physical Examination , Symptom Assessment , Pediatrics , Spain , Fasciitis, Necrotizing/drug therapy , Fasciitis, Necrotizing/surgeryABSTRACT
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.
Subject(s)
Fasciitis, Necrotizing , Laparoscopy , Female , Humans , Aged , Fasciitis, Necrotizing/surgery , Fasciitis, Necrotizing/diagnosis , Multiple Organ Failure/etiology , DebridementABSTRACT
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.
Subject(s)
Fasciitis, Necrotizing , Shock, Septic , Soft Tissue Infections , Adult , Female , Humans , Male , Cohort Studies , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/surgery , Retrospective Studies , Soft Tissue Infections/diagnosis , Soft Tissue Infections/surgery , Middle Aged , Aged , Aged, 80 and overABSTRACT
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.
Subject(s)
Fasciitis, Necrotizing , Soft Tissue Infections , Female , Humans , Fasciitis, Necrotizing/etiology , Fasciitis, Necrotizing/surgery , Mastectomy, Segmental/adverse effects , Soft Tissue Infections/surgery , Fascia , MastectomyABSTRACT
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.
Subject(s)
Drugs, Chinese Herbal , Fasciitis, Necrotizing , Petrolatum , Wound Healing , Humans , Wound Healing/drug effects , Male , Female , Middle Aged , Fasciitis, Necrotizing/drug therapy , Fasciitis, Necrotizing/surgery , Drugs, Chinese Herbal/therapeutic use , Drugs, Chinese Herbal/pharmacology , Adult , Petrolatum/therapeutic use , Bandages , Aged , Materia MedicaABSTRACT
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.
Subject(s)
Fasciitis, Necrotizing , Plastic Surgery Procedures , Humans , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/surgery , Debridement/methods , Streptococcus pyogenes , Extremities/surgery , Anti-Bacterial Agents/therapeutic useABSTRACT
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.
Subject(s)
Diabetes Mellitus , Diabetic Foot , Fasciitis, Necrotizing , Humans , Povidone-Iodine/therapeutic use , Diabetic Foot/surgery , Fasciitis, Necrotizing/surgery , Retrospective Studies , Wound HealingABSTRACT
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.
Subject(s)
Fasciitis, Necrotizing , Soft Tissue Infections , Humans , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/surgery , Soft Tissue Infections/diagnosis , Soft Tissue Infections/surgery , Prospective Studies , Resource-Limited Settings , Retrospective Studies , Risk FactorsABSTRACT
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.
Subject(s)
Diabetes Mellitus , Diabetic Foot , Fasciitis, Necrotizing , Humans , Leg , Fasciitis, Necrotizing/complications , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/surgery , Diabetic Foot/complications , Diabetic Foot/diagnosis , Diabetic Foot/surgery , Lower Extremity , Amputation, SurgicalABSTRACT
Necrotizing fasciitis is a clinical, surgical emergency characterized by an insidious onset, rapid progression, and a high mortality rate. The disease's mortality rate has remained high for many years, mainly because of its atypical clinical presentation, which prevents many cases from being diagnosed early and accurately, resulting in patients who may die from uncontrollable septic shock and multi-organ failure. But unfortunately, no diagnostic indicator can provide a certain early diagnosis of NF, and clinical judgement of NF is still based on the results of various ancillary tests combined with the patient's medical history, clinical manifestations, and the physician's experience. This review provides a brief overview of the epidemiological features of NF and then discusses the most important laboratory indicators and scoring systems currently employed to diagnose NF. Finally, the latest progress of several imaging techniques in the early diagnosis of NF and their combined application with other diagnostic indices are highlighted. We point out promising research directions based on an objective evaluation of the advantages and shortcomings of different methods, which provide a basis for further improving the early diagnosis of NF.