Necrotizing fasciitis: reviewing the causes and treatment strategies.
ABSTRACT PURPOSE: To update the practitioner with causes, diagnosis, and treatment options for necrotizing fasciitis. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in better understanding the pathophysiology, diagnosis, and treatment of necrotizing fasciitis. OBJECTIVES: After reading this article and taking this test, the reader should be able to: 1. Identify the risk factors and causes of necrotizing fasciitis (NF). 2. Describe the clinical presentation and diagnosis of NF. 3. Explain the treatment options for NF.
SourceAvailable from: Gerson Alves Pereira Junior[Show abstract] [Hide abstract]
ABSTRACT: Skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions ranging from simple superficial infections to severe necrotizing soft tissue infections. Necrotizing soft tissue infections (NSTIs) are potentially life-threatening infections of any layer of the soft tissue compartment associated with widespread necrosis and systemic toxicity. Successful management of NSTIs involves prompt recognition, timely surgical debridement or drainage, resuscitation and appropriate antibiotic therapy. A worldwide international panel of experts developed evidence-based guidelines for management of soft tissue infections. The multifaceted nature of these infections has led to a collaboration among surgeons, intensive care and infectious diseases specialists, who have shared these guidelines, implementing clinical practice recommendations.World Journal of Emergency Surgery 11/2014; 9(1):57. DOI:10.1186/1749-7922-9-57 · 1.06 Impact Factor
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ABSTRACT: Necrotizing fasciitis (NF) is a deadly soft tissue infection characterized by necrosis of subcutaneous tissues. In this study, our aim was to identify variables affecting patient outcome and mortality in necrotizing fasciitis and their temporal changes. We reviewed records of 45 patients treated at our institution between 1979 and 2004. Data about gender, age, etiology, site of involvement, bacteriology, type of surgery, supportive treatment, accompanying diseases, mortality were collected. Factors contributing to mortality were sepsis, renal failure, liver failure, multi organ failure, disseminated intravascular coagulopathy and long term intubation. Mortalities accumulated in first 23 patients. There was not difference in microbiology, demographics, etiology, site of involvement, debridement technics between first patients and recent patients of the institution. Mortality in necrotizing fasciitis is mostly because of sepsis and associated disorders. Adequate control of the microbiological agent and preventing further contamination of the wound is cardinal part of treatment in NF.
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ABSTRACT: Necrotizing soft tissue infections: Review and current concepts in treatment, systems of care, and outcomes Introduction Necrotizing soft tissue infections (NSTIs) rank among the more difficult disease processes encountered by physicians and surgeons. NSTIs can arise primarily in the dermis and epidermis, but they more commonly affect the deeper layers of adipose tissue, fascia, or muscle. NSTIs are typically caused by toxin-producing bacteria and are characterized clinically by very rapid progression of disease with significant local tissue destruction. Varying amounts of early or late systemic toxicity depend on the strain of bacteria and toxins produced. Once symptomatic, the progression of disease is typically measured in hours; early diagnosis and treatment are crucial to survival. Diagnosis is hindered by the fact that the disease progresses below the surface, and the cutaneous manifestations belie the severity of disease. As the infection disseminates, patients develop pain and signs of systemic toxicity disproportionate to the findings of skin examination, and physicians must maintain a high index of suspicion to rapidly diagnose NSTIs. The standard treatment consists of broad-spectrum antibiotics, wide surgical debridement, and supportive care. Most patients require multiple surgical debridements, and survivors often have large and complex wounds requiring soft tissue coverage and prolonged hospitalizations. Even with optimal treatment, NSTIs portend significant morbidity and have mortality rates of 25%-35% in recent series. In this review, we provide historical context; discuss the epidemiology, etiology, and pathogenesis of disease; summarize the major microbiology; and elaborate the clinical presentation and diagnosis of disease with a special discussion of NSTIs in immune- compromised patients. We then outline the major and novel treatment strategies, organized by phase of treatment and with special emphasis on the importance of multidisciplinary care teams. Finally, we summarize the information on in-hospital outcomes and close with a brief discussion of posthospital and developing information on long-term quality of life and functional outcomes.Current Problems in Surgery 08/2014; DOI:10.1067/j.cpsurg.2014.06.001 · 1.42 Impact Factor