Necrotizing fasciitis (NF) is an uncommon soft tissue infection, usually caused by toxin-producing virulent bacteria. It is characterized by widespread fascial necrosis primarily caused by Streptococcus hemolyticus. Shortly after the onset of the disease, patients become colonized with their own aerobic and anaerobic microflora from the gastrointestinal and/or urogenital tracts. Early diagnosis with aggressive multidisciplinary treatment is mandatory. We describe three clinical cases with NF. The first is a 69 years old man with diabetes mellitus type II, who presented with NF on the posterior chest wall, shoulder and arm. He was admitted to the intensive care unit (ICU) with a clinical picture of severe sepsis. Outpatient treatment and early surgical debridement of the affected zones (inside 3 hours after admittance) and critical care therapy were performed. The second case is of a 63 years old paraplegic man with diabetes mellitus type I. Pressure sores and perineal abscesses progressed to Fournier's gangrene of the perineum and scrotum. He had NF of the anterior abdominal wall and the right thigh. Outpatient treatment and early surgical debridement of the affected zones (inside 6 hour after admittance) and critical care therapy were performed. The third patient was a 56 year old man who had NF of the anterior abdominal wall, flank and retroperitoneal space. He had an operation of the direct inguinal hernia, which was complicated with a bowel perforation and secondary peritonitis. After establishing the diagnosis of NF of the abdominal wall and retroperitoneal space (RS), he was transferred to the ICU. There he first received intensive care therapy, after which emergency surgical debridement of the abdominal wall, left colectomy, and extensive debridement of the RS were done (72 hours after operation of inquinal hernia). On average, 4 serial debridements were performed in each patient. The median of serial debridement in all three cases was four times. Other intensive care therapy with a combination of antibiotics and adjuvant hyperbaric oxygen therapy (HBOT) was applied during the treatment. After stabilization of soft tissue wounds and the formation of fresh granulation tissue, soft tissue defect were reconstructed using simple to complex reconstructive methods.

HBO therapy reduced the frequency of wound complications in patients with Gustilo type III wounds and shortened the time to granulation formation. HBO therapy was more effective in non-NATO than in NATO treated patients for the prevention of deep soft-tissue infection but not flap necrosis.

Abdominoplasty is an extensive surgical operation, often followed by a significant number of local and general complications. Some studies indicate that the risk of severe complications, including mortality, ranges from 1 in 617 to 1 in 2,320 cases. Seroma is one of the serious consequences that follows each type of abdominal contour surgery, from suction-assisted lipoplasty to standard and limited abdominoplasty. A case of a 46-year-old women who underwent standard abdominoplasty and liposuction during the same procedure is presented. In the follow-up examination, a chronic seroma with pseudobursa was observed. The pseudobursa was evacuated multiple times under ultrasound control. During one evacuation, 2,010 ml of seroma was evacuated. Because of the prolonged Seroma formation, the pseudobursa grew, creating a tumor-like effect in the front abdominal wall. In a second operation (miniabdominoplasty), the pseudobursa was completely excised, and the material was sent for analysis. Progressive tension sutures were placed in additional lines to decrease the dead space, and to decrease movement between the abdominal flap and the musculoaponeurotic layer, as suggested by Saltz and Matarasso. Suction drainage with a compressive girdle was maintained for 2 weeks after the second operation. The follow-up assessment, performed 3 months after the second operation, showed no infection, skin necrosis, hernia formation, or new chronic seroma with pseudobursa.

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