Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Fasciitis, Necrotizing”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMedDate not supplied

Burn center management of necrotizing fasciitis.

Necrotizing fasciitis is a rapidly progressive soft-tissue infection associated with significant morbidity and mortality. Necrotizing fasciitis is similar to invasive burn wound infection in that diagnosis requires histologic examination of affected tissue and treatment requires aggressive surgical debridement followed by skin autograft. Transfer to a burn center facilitates the management of necrotizing fasciitis, where requisite surgical and nursing expertise is available. We reviewed the experience of one burn center in the management of necrotizing fasciitis over a 5-year period. Ten patients were transferred to the burn center from other medical facilities for care, arriving a mean of 8.9 days after initial hospital admission. The diagnosis was made by a surgical service or consultation before transfer in all cases; initial admission to a medical rather than a surgical service delayed surgery in five cases. All patients had surgical debridement before transfer but required a mean of 5.1 additional operations at the burn center. Although the mean extent of involvement was 14.8% body surface area, the mean length of burn center stay was 34.9 days. Complications were frequent, including pulmonary failure requiring mechanical ventilation (n = 6), renal insufficiency or failure (n = 5), hypotension requiring pressers (n = 4), deep venous thrombosis (n = 3), and pulmonary emboli (n = 1). Overall mortality was 2 of 10 patients (20%). Both fatalities were associated with delay in initial surgical procedure and in transfer to the burn center. The similarity of necrotizing fasciitis and invasive burn wound infection makes the burn center the ideal setting for the treatment of this disease. We advocate the addition of necrotizing fasciitis to the list of conditions currently recognized by the American Burn Association as appropriate for burn center transfer and care.

Adult↗
PubMed1996

[Multiple myeloma complicated by necrotizing fasciitis].

Necrotizing fasciitis is a rare but often fatal soft-tissue infection primarily involving the superficial fascia and fat tissue resulting in extensive undermining of surrounding tissues. Skin is initially spared, but as necrotizing fasciitis spreads, all the soft-tissue components, including the skin, become involved. The progression of necrotizing fasciitis is often fulminant, and the prognosis depends to a large extent on the rapidity of correct diagnosis and surgical treatment (debridement). Most of the patients affected with necrotizing fasciitis have some risk factors: chronic general or local diseases, leukopenia, immunodeficiency diseases, malignancies, and an age of 50 years or more. The author reported the occurrence of necrotizing fasciitis in a 69-year-old man with multiple myeloma during the granulocytopenic phase after chemotherapy. The successful treatment of necrotizing fasciitis in the present case relied not only on surgical debridement, but also on G-CSF administration.

Aged↗
PubMedDate not supplied

Life-threatening necrotizing fasciitis.

Necrotizing fasciitis is characterized by a rapidly progressing necrosis of subcutaneous fat and fascia, which can be life-threatening without prompt recognition, surgical intervention, and immediate antibiotic therapy. Necrotizing fasciitis has been subdivided into type 1, or polymicrobial necrotizing fasciitis, and type 2, or group A streptococcal necrotizing fasciitis. In addition, synonyms, such as streptococcal gangrene and "flesh-eating bacteria syndrome," have been used in the literature.

Diagnosis, Differential↗
PubMed2001

Necrotizing fasciitis.

Necrotizing fasciitis is a devestating condition which has been recognized for several years. In North America a recent increase of cases has led to much media attention and public fear. Necrotizing fasciitis may occur as a consequence of infection with Streptococcus pyogenes or as a result of a polymicrobial synergistic infection caused by aerobic, anaerobic, gram positive and gram negative organisms, often in postoperative patients. Necrotizing fasciitis caused by Streptococcus pyogenes is mediated by superantigens. The management of necrotizing fasciitis requires a high index of suspicion for diagnosis followed by antimicrobial therapy and early surgical intervention. In cases caused by Streptococcus pyogenes with streptococcal toxic shock syndrome, intravenous immunoglobulin may be of benefit.

Diagnosis, Differential↗
PubMed1999

Cervical necrotizing fasciitis.

Necrotizing fasciitis is a severe soft tissue infection that results in necrosis of the fasciae and subcutaneous tissues; the infection can quickly prove fatal. Although involvement of the head and neck is rare, causes are usually odontogenic or pharyngeal but can also be insect bites, local trauma, burns or surgery. We present a clinical case of a 31-year-old Italian woman with cervical necrotizing fasciitis having an uncommon presentation. While under treatment, the patient's husband was admitted for necrotizing fasciitis of the medial fasciae of his left leg subsequent to an insect sting. The causes, diagnosis and treatment of necrotizing fasciitis are reviewed.

Adult↗
PubMed1983

Necrotizing fasciitis.

Necrotizing fasciitis has long been recognized as an acute life-threatening infection requiring aggressive treatment. It generally occurs after minor trauma, but often there is no history of injury. The skin in necrotizing fasciitis is pale or red with no clear line of demarcation between affected and normal skin. There is extensive undermining of the skin with a foul-smelling sanguineous exudate. The superficial fascia and the deep fascia can be easily separated and will appear stringy, ragged, and dull gray to gray-green in color. Muscle, bone, or viseral involvement is not a feature of necrotizing fasciitis. The systemic response is one of an acutely ill patient with prostration and clouding of sensorium. Anemia, low serum calcium level, and fluid volume deficits are commonly seen along with other nonspecific laboratory and clinical findings common to serious acute infections. Necrotizing fasciitis is a polymicrobial disorder and not a specific bacterial infection. Beta-hemolytic streptococci, Staphylococcus aureus, and mixed gram-negative organisms are most frequently reported as etiologic agents, with more recent reports usually demonstrating a combination of anaerobic and facultative anaerobic bacteria. The primary therapy consists of radical surgical debridement of all nonviable tissue with frequent postoperative checks to monitor for further dissection that would require additional surfical debridement. Local wound care consists of diligent cleaning and application of loose gauze soaked with a topical agent. Parenteral antibiotic therapy based upon the Gram stain and further modified on the basis of bacterial culture and sensitivity studies, is started immediately. Management also involves correction of fluid and electrolyte imbalances, correction of anemia, and general supportive care.(ABSTRACT TRUNCATED AT 250 WORDS)

Debridement↗
PubMed1996

Necrotizing fasciitis.

Necrotizing fasciitis is an uncommon soft-tissue infection, usually caused by toxin-producing, virulent bacteria, which is characterized by widespread fascial necrosis with relative sparing of skin and underlying muscle. It is accompanied by local pain, fever, and systemic toxicity and is often fatal unless promptly recognized and aggressively treated. The disease occurs more frequently in diabetics, alcoholics, immunosuppressed patients, i.v. drug users, and patients with peripheral vascular disease, although it also occurs in young, previously healthy individuals. Although it can occur in any region of the body, the abdominal wall, perineum, and extremities are the most common sites of infection. Introduction of the pathogen into the subcutaneous space occurs via disruption of the overlying skin or by hematogenous spread from a distant site of infection. Polymicrobial necrotizing fasciitis is usually caused by enteric pathogens, whereas monomicrobial necrotizing fasciitis is usually due to skin flora. Tissue damage and systemic toxicity are believed to result from the release of endogenous cytokines and bacterial toxins. Due to the paucity of skin findings early in the disease, diagnosis is often extremely difficult and relies on a high index of suspicion. Definitive diagnosis is made at surgery by demonstration of a lack of resistance of normally adherent fascia to blunt dissection. Treatment modalities include surgery, antibiotics, supportive care, and hyperbaric oxygen. Early and adequate surgical debridement and fasciotomy have been associated with improved survival. Initial antibiotic therapy should include broad aerobic and anaerobic coverage. If available, hyperbaric oxygen therapy should be considered, although to our knowledge, there are no prospective, randomized clinical trials to support this. Mortality rates are as high as 76%. Delays in diagnosis and/or treatment correlate with poor outcome, with the cause of death being overwhelming sepsis syndrome and/or multiple organ system failure.

Fasciitis, Necrotizing↗
PubMed2005

Microbiology and factors affecting mortality in necrotizing fasciitis.

Necrotizing fasciitis is a life-threatening soft-tissue infection primarily involving the superficial fascia. This study investigated the microbiologic characteristics and determinants of mortality of this disease. The medical records of 87 consecutive patients with a diagnosis of necrotizing fasciitis from 1999 to 2004 were retrospectively reviewed. A single pathogen was identified as the infectious agent in 59 patients (67.8%), multiple pathogens were identified in 17 patients (19.6%), and no organism was identified in 11 patients (12.6%). Klebsiella pneumoniae, identified in 17 patients, was the most commonly isolated species. The most common comorbidity was diabetes mellitus (41 patients; 53.2%). Multivariate logistic regression analysis showed that more than 1 comorbidity, thrombocytopenia, anemia, more than 24 h delay from onset of symptoms to surgery and age greater than 60 were independently associated with mortality. This study found that K. pneumoniae was the most common cause of necrotizing fasciitis. Early operative debridement was independently associated with lower mortality.

Adolescent↗
PubMed2002

[Diagnosis and therapy of necrotizing fasciitis].

Necrotizing fasciitis is a soft tissue infection with a lethality ranging up to 80%. Infection causes the activation of interleukin, tumor necrosis factor alpha, and gamma-interferon through a triggering mechanism. This results in a capillary thrombosis with necrosis of the fascia, cutis, and subcutis. The patient's history often reveals a triggering event in the form of a recent minimal trauma or operative procedure. In a fulminant necrotizing fasciitis, the development of sepsis with consecutive multiple-organ failure mainly determines the outcome of the disease. Diagnosis is made initially upon clinical findings with a rapid progression of the disease and confirmed later by histologic and microbiologic findings. Radical surgical debridement within the first 24 h with postoperative treatment in an intensive care unit represents the cornerstone of therapy. Between January 1992 and March 2001, we treated 15 patients with necrotizing fasciitis. Lethality was 33%. There was a significant correlation between risk factors (present in 86% of the patients) and morbidity. Diagnosis and therapy should be performed by an experienced surgeon. In this contribution, we discuss the most important criteria that lead to the diagnosis and the therapeutic consequences.

Adult↗
PubMed1994

Pyoderma gangrenosum complicated by necrotizing fasciitis.

Necrotizing fasciitis is a potentially life-threatening infection that may resemble extensive pyoderma gangrenosum. The treatment of the two diseases is, however, different, and differentiating them is therefore essential. A case is presented in which necrotizing fasciitis appeared as a complication of pyoderma gangrenosum. The successful treatment is described, and the differential diagnosis of the two entities is presented. The need for early and aggressive treatment of necrotizing fasciitis is stressed.

Aged↗
PubMed1992

Retroperitoneal necrotizing fasciitis.

Necrotizing fasciitis is a mixed infection of the skin and subcutaneous tissues with a characteristic clinical and pathological appearance. Early radical surgical excision of all affected tissue is the treatment of choice. In a series of 19 patients with necrotizing fasciitis, bacteriological assessment in 15 confirmed the mixed nature of the infection, with Bacteroides sp. isolated from ten patients. All 12 patients who underwent radical surgical excision survived. A subgroup of patients was identified in whom the appearance of necrotizing fasciitis in the abdomen or perineum was indicative of more extensive disease in the retroperitoneal tissues. Surgical resection of all affected tissue was not feasible in these cases and the outcome was uniformly fatal, giving an overall mortality rate for the series of 37 per cent.

Aged↗
PubMed2004

Bilobed fasciocutaneous flap for reconstruction of the posterior neck after necrotizing fasciitis.

Necrotizing fasciitis is an aggressive, deep-seated infection of the fascia and subcutaneous fat with necrosis of overlying skin. Eleven cases of necrotizing fasciitis of the posterior neck are reviewed to demonstrate the advantage of using a bilobed fasciocutaneous flap for repair following surgical debridement. Nine men and two women aged 40 to 65 years (mean age, 54.8 years) presented for reconstruction from April of 1999 to March of 2003. The blood supply of the bilobed fasciocutaneous flap originates from a constant row of musculocutaneous perforators of posterior intercostal arteries. The technique enabled regional reconstruction, conserved tissues, and provided satisfactory aesthetic results.

Arteries↗
PubMed1998

[Necrotizing fasciitis].

Necrotizing fasciitis is a rare soft tissue infection with a high rate of mortality. Decreased capacity of the immune response is the overall disposing factor. Necrotizing fasciitis can develop very rapidly, and a rapid diagnosis and aggressive surgery provides the best prognosis.

Amputation, Surgical↗
PubMed1996

Necrotizing fasciitis.

Necrotizing fasciitis is a life-threatening, invasive soft-tissue infection that is characterized by widespread, rapidly developing necrosis of the subcutaneous tissue and fascia. It is more likely to occur in patients with a compromised immune system. In type I necrotizing fasciitis, anaerobes and gram-negative bacteria are predominant; in the type II form, the bacterial etiology is group A beta-hemolytic streptococci. The diagnosis must be made on the basis of clinical grounds and is characterized by rapidly developing, painful erythema that progresses to bullous formation and gangrenous necrosis.

Adult↗
PubMed2000

[Necrotizing fasciitis].

Necrotizing fasciitis is a progressive destructive infection in the subcutaneous tissue. It represents a serious problem in medicine both in making the correct early diagnosis and in treatment. We describe the symptoms, the clinical and paraclinical findings and the guidelines for treatment. Nine cases of necrotizing fasciitis are reported schematically, three cases are presented in text. Only two patients survived, one of these received intravenous immunoglobulin. Of the seven dead, five received intravenous immunoglobulin.

Aged↗
PubMed2001

[The therapeutic approach to necrotizing fasciitis].

Necrotizing fasciitis are characterized by the necrosis of fascias, and their severe consequences in terms of morbidity and mortality. An early diagnosis, based on sometimes subtle cutaneous lesions (associated to a sepsis syndrome) allows to start resuscitation and decide on a probable surgery. 3 major forms can be distinguished: streptococcal fasciitis, due to beta-hemolytic streptococci, often following minor trauma, and increasingly associated to a streptococcal toxic shock syndrome (STTS); clostridial gangrene (often polymicrobial when developed on a open wound or after surgery); and synergistic gangrene due to a mixed aerobic-anaerobic flora. Other apparently "primitive" necrotizing fasciitis, caused by specific organisms, may occur in debilitated patients. The prognosis depends on age, comorbidity, and above all on the severity of the sepsis syndrome. Initial resuscitation involves controlling the hypotension and organ dysfunction associated with severe sepsis, and is usually dominated by a severe hypovolemia. Penicillin G remains the key antibiotic for streptococcal and clostridial fasciitis, with a broad spectrum including enterobacteriaceae, streptococci and enterococci, and anaerobes (including Bacteroides spp.) in other types or when the etiology is unknown. In patients presenting with STSS, a combination of clindamycin (or rifampin) to penicillin is recommended, because of their effect on exotoxin production; administration of non-specific immunoglobulins also appears to improve the outcome of patients affected. Hyperbaric oxygen therapy has not proved effective. Early surgical debridement largely influences the prognosis. The prevention of complications associated with long-term intensive care, including early nutritional support and prevention of a thromboembolic disease, is also important.

Fasciitis, Necrotizing↗
PubMed1996

Necrotizing fasciitis.

Necrotizing fasciitis is a rapidly progressing soft-tissue infection characterized by extensive necrosis of subcutaneous fat and fascia. It is frequently accompanied by moderate to severe systemic toxicity and can be fatal without prompt recognition and aggressive surgical treatment. The podiatric physician must be aware of these infections because the extremities are common sites of involvement. Necrotizing, fasciitis must be treated as a medical emergency calling for prompt surgical intervention and high doses of broad-spectrum antibiotics.

Adult↗