Necrotizing fasciitis

Fourteen patients with necrotizing fasciitis seen over a 5 year period at a public hospital are reviewed. Middleaged men predominated. The disease followed such diverse initiating causes as self-injection with heroin, boil, ischiorectal abscess, perforated occult colonic cancer and trivial abrasions. In a few cases there was no evidence of an initiating lesion. Necrotizing fasciitis affected the arms, legs, trunk and neck. Bacteriologic analysis showed that the disease is usually caused by gram-negative bacilli and hemolytic streptococci, alone or in combination. Morbidity and mortality rates in the present series were influenced by associated clinical conditions such as old age, diabetes mellitus, carcinoma and gram-negative bacteremia.     

Necrotizing fasciitis

Necrotizing fasciitis can be a devastating infectious process when diagnosis and early aggressive therapy is delayed. The etiologic factors that may play a role in or affect this necrotizing infectious process are reviewed. An interesting case is presented of bilateral, lower extremity, necrotizing fasciitis in a patient with diabetes mellitus, peripheral vascular disease and profound sensory neuropathy.     

Necrotizing fasciitis

An experience with treatment of four patients with necrotizing fasciitis (NF) and a review of literature were used to characterize this rare but dangerous for life disease, The pathogen of NF is a hemolytic group A streptococcus and anaerobes. The mechanism of the development of fasciitis is based on impairments in the microcirculatory bed due to the action on the cytokine endothelium. Rapidly progressing necrosis of fasciae results in a number of complications. The treatment consists of the early and aggressive necrectomy and intensive antibiotic therapy in combination with immunomodulation.     

Necrotizing fasciitis

Necrotizing fasciitis was diagnosed in 16 patients during the years 1980 to 1984. All patients were managed by a uniform protocol consisting of radical excisional surgery, intravenous antibiotics, and hyperbaric oxygen therapy. An overall mortality rate of 12.5% was achieved. In view of the encouraging results, this therapeutic regimen is highly recommended.     

Necrotizing fasciitis

The management of a right foot necrotizing fasciitis and severe sepsis in an old diabetic patient is presented. The early and aggressive surgery, adequate antibiotherapy and correction of organic disfunction (cardio-circulatory, renal, respiratory) eliminated the vital risk and resulted in a satisfactory morpho-functional recovery of the foot.     

Necrotizing fasciitis

Ten cases of necrotizing fasciitis are reviewed. Three patients died but only two of these deaths were due to uncontrolled septicaemia. All isolated organisms were sensitive to a combination of piperacillin and ampicillin which we now regard as the initial antibiotic combination of choice. Prompt and aggressive surgical debridement remains the cornerstone of management.     

Necrotizing pancreatitis: diagnosis and management

Necrotizing pancreatitis is a severe disease characterized by gland necrosis and a destructive systemic inflammatory response. Early management involves aggressive resuscitative and supportive measures. Outcomes are primarily determined by the presence of late secondary bacterial infection of the necrotic gland. Early empiric antibiotics and late surgical necrosectomy in the appropriate setting are the keys to managing these sick patients. With appropriate management, mortality can be minimized and long-term quality of life may be restored.     

Necrotizing fasciitis: Diagnosis and management of an occult infective focus

Necrotizing fasciitis is a life-threatening, fulminant disease that is a diagnostic and therapeutic challenge. Presenting with a triad of findings including progressive erythema, severe dermatological edema and severe pain disproportionate to the physical findings, this disease is a surgical emergency. Delayed diagnosis and surgical debridement lead to higher mortality. Early extensive surgical debridement, aggressive antibiotic therapy, invasive monitoring and intensive care management determine the outcome in most cases. In patients who fail to demonstrate clinical improvement, profound sepsis and its sequela –systemic inflammatory response – have frequently been implicated. It is these patients that need to be carefully re-evaluated for ‘hidden’ foci of infection that may be the real cause of the patient’s decline. Once detected, these occult foci can be surgically debrided, resulting in dramatic improvement. Two illustrative cases, one with occult endo- and panophthalmitis and the other with an unusual involvement of deeper muscle planes and the nodal basin, demonstrate this point. This consumptive process gathers momentum at an alarming speed, hence, the treatment must be aggressive and prompt.     

Idiopathic necrotizing fasciitis: risk factors and strategies for management

The prognosis of necrotizing fasciitis (NF) depends on early diagnosis and management. Idiopathic NF may be more challenging, because it occurs in the absence of a known causative factor. Therefore, our purpose in this study was to identify the distinct features of idiopathic NF that may be important in early recognition of this disease and determine the factors associated with mortality. A retrospective chart review was performed in patients with a diagnosis of NF between 1988 and 2003. Patients were classified as idiopathic and secondary NF, and data were analyzed in terms of etiological and predisposing factors, causative microbiological organisms, and clinical outcome. The study included 98 patients, 63 men and 35 women, with a diagnosis of NF. The median age was 55.5 years (range, 13 - 80). Idiopathic NF occurred in 60 of 98 patients (61%). The principal anatomic sites of infection for NF were perineal localisation in 55 patients (66%) and extremities in 31 patients (32%). Characteristics that distinguish patients with idiopathic NF from secondary NF were as follows: age older than 55 years (P = 0.0001), presence of comorbid illnesses like DM (P = 0.007) or chronic renal failure (P = 0.041), and perineal localization (P = 0.008). By logistic regression analysis, independent risk factors for idiopathic NF remained age > 55 years and perineal localization as statistically significant factors, when all the significant variables found in univariate analysis were included in the model. The majority of patients (82%) had polymicrobial infections. The mortality rate was 35 per cent. All patients were treated with radical surgical debridement and a combination of antibiotics. Female gender, presence of malignant disease, and diabetes mellitus (DM) were found to be associated with increased mortality as independent factors in logistic regression analysis, when all of these three factors were included in the model. Understanding the distinct clinical characteristics and the factors associated with mortality in patients with NF may lead to rapid diagnosis and improve the survival rates. Therefore, idiopathic NF is a crucial entity that requires serious suspicion for its diagnosis.     

Necrotizing fasciitis: our experience

Necrotizing fasciitis is a rare and dramatic soft-tissue; infection starting from the subcutaneous tissue, involving the fascia and the underlying muscle and causes necrosis and, suddenly, gangrene. Most frequently the necrotizing fasciitis is localized in anorectal or genitourinary region and in traumatized muscles. Its mortality rate is 20%. Predisposing factors for these infections have included advanced age, obesity, hypertension, atherosclerosis, malnutrition, renal failure, immunosuppression and, primarily, diabetes mellitus. The infection is caused by a lot of gram +, gram -, and anaerobic bacteria that act synergistically. The early diagnosis, a correct chemotherapy, an aggressive surgical treatment of the necrotic area and hyperbaric oxygen treatment allow the patient's recovery, dramatically reducing the functional consequences. The Authors analyze retrospectively five cases of necrotizing fasciitis observed in the last two years (August 2001-August 2003) and stress clinical findings and surgical treatment.