353 Improving Outcomes in Fournier’s Gangrene Using Skin and Soft Tissue Sparing Flap Preservation Surgery: An Alternative Approach to Wide Radical Debridement

Perry, Travis L; Kranker, Lindsay; Curry, Eileen; Johnson, R Michael; Mobley-Smith, E

doi:10.1093/jbcr/iry006.275

Cited by 9 publications

(16 citation statements)

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“…Necrotic areas at the distal flap are characterized by profound coagulative necrosis and inflammatory cell infiltration. Additionally, the extent of tissue necrosis has been associated with the degree of inflammatory responses ( Perry et al, 2018 ). Hence, preventing immune responses and inflammation can improve flap survival.…”

Section: Discussionmentioning

confidence: 99%

Effects of Apigenin Treatment on Random Skin Flap Survival in Rats

Lin

Liu

et al. 2021

Front. Pharmacol.

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Random skin flaps are often used in plastic surgery, but the complications of marginal flap ischemia and necrosis often limit their wider clinical application. Apigenin (Api) is a flavonoid found in various fruits and vegetables. Api has been shown to promote angiogenesis, as well as reduce oxidative stress, membrane damage, and inflammation. In this study, we assessed the effects of Api treatment on random skin flap survival. Dorsal McFarlane skin flaps were transplanted into rats, which were randomly divided into three groups: control (normal saline), low-dose Api (20 mg/kg), and high-dose Api (50 mg/kg). Seven days after the surgery, the activity of superoxide dismutase (SOD) and the level of malondialdehyde (MDA) were measured. Histological analyses were performed to determine flap survival and tissue edema. H&E staining was performed to assess the histopathological changes in skin flaps, and the levels of microvascular density (MVD) were determined. Laser doppler flowmetry was used to assess microcirculation blood flow. Flap angiography was performed by injection of lead oxide/gelatin. The expression levels of vascular endothelial growth factor (VEGF), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interlukin-1β (IL-lβ) were evaluated by immunohistochemistry. Rats in the high-dose Api group exhibited higher average flap survival area, microcirculatory flow, increased SOD activity, and higher VEGF expression levels compared with the other two groups. Furthermore, the levels of MDA and pro-inflammatory cytokines were significantly decreased in rats treated with high-dose Api. Our findings suggest the potential usefulness of Api in preventing skin flap tissue necrosis.

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Section: Discussionmentioning

confidence: 99%

Effects of Apigenin Treatment on Random Skin Flap Survival in Rats

Lin

Liu

et al. 2021

Front. Pharmacol.

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“…One of the few studies showed that wounds can be closed earlier on and that fewer patients required skin grafts [ 32 ]. However, in most studies on the skin sparing approach the technique was mainly used during the secondary debridement in transferred patients (85%) and in patients in who the initial debridement was not performed skin sparing (32–71%), limiting conclusion to be drawn about outcomes of the approach if it is used during the initial debridement [ 32 , 33 ]. Preventing mortality by performing adequate source control remains the primary goal with extra consideration for long-term function and aesthetics as secondary goals.…”

Section: Discussionmentioning

confidence: 99%

Incidence and mortality of necrotizing fasciitis in The Netherlands: the impact of group A Streptococcus

et al. 2021

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Background Little is known about the exact incidence of necrotizing soft tissue infections. The few incidences reported in international literature are not directly relatable to the Netherlands, or other European countries, due to geographic heterogeneity in causative micro-organisms involved. This resulted in the aim of this study to map the incidence, mortality rate and hospital course of necrotizing fasciitis infections in the Netherlands to gain insight in the incidence of necrotizing fasciitis in the Netherlands and the associated mortality and health care burden. Methods This nationwide retrospective database study used three distinct data sources to map the incidence of necrotizing fasciitis in the Netherlands between 2014 and 2019, being data from the Dutch Hospital Data (DHD) foundation, data from Osiris-AIZ, which is a database of notifiable diseases managed by regional Public Health Services (GGD) and the National Institute for Public Health and the Environment (RIVM), and previously published studies on necrotizing fasciitis conducted in the Netherlands. Results The incidence of necrotizing fasciitis in the Netherlands is estimated to be approximately 1.1 to 1.4 cases per 100,000 person years, which corresponds to 193–238 patients per year. Of all necrotizing fasciitis infections, 34 to 42% are caused by the group A Streptococcus. Annually, 56 patients die as a result of a necrotizing fasciitis infection (mortality of 23–29%) and 26 patients undergo an amputation for source control (11–14%). Patients stay a mean of 6 to 7 days at the intensive care unit and have a mean hospital length of stay of 24 to 30 days. Conclusion The combination of nationwide databases provides reliable insight in the epidemiology of low-incidence and heterogenic diseases. In the Netherlands, necrotizing fasciitis is a rare disease with group A Streptococcus being the most common causative micro-organism of necrotizing fasciitis. The prior Dutch cohort studies on necrotizing fasciitis report slightly higher sample mortality rates, compared to the population mortality. However, necrotizing fasciitis remain associated with substantial morbidity and mortality, risk at amputation and health care burden characterized by prolonged ICU and hospital stay.

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“…Serial surgical debridement coupled with negative-pressure wound therapy (NPWT) has been reported as safe, and it saves skin and soft tissue if needed for flaps to treat Fournier's gangrene [ 13 ]. At her first presentation, our patient displayed extensive skin changes suggesting ischemia.…”

Section: Discussionmentioning

confidence: 99%

A case report of necrotizing soft tissue infection of the chest wall: Effective management with serial debridement

Fujii

Imamura

Kato

et al. 2021

International Journal of Surgery Case Reports

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Introduction Necrotizing soft tissue infection (NSTI) of the chest wall is a rare, rapidly spreading, highly lethal surgical disease. Radical debridement interferes with the important anatomical function of the chest wall. We report a case of chest wall NSTI that was successfully managed with early diagnosis and serial debridement. Presentation of case A 43-year-old, previously healthy woman presented with severe malaise and worsening right axillary pain. She was severely lethargic and had a painful, large, pale lesion with surrounding erythema of the right chest and trunk. Computed tomography revealed NSTI, with diffuse soft tissue inflammation extending from the axilla to the lower abdomen. There was no obvious entry portal. Prompt surgical drainage was established. Group A streptococcus infection was diagnosed. During her 3-month postoperative course, she underwent four more surgeries, including two debridements. This treatment proved successful and avoided the need for complicated muscle flap reconstruction. She was discharged on postoperative day 109. Discussion Group A streptococcus can cause NSTI even in immunocompetent patients without an entry portal. Radical debridement is recommended for infection control. Preserving anatomical chest wall function, however, is also important. Serial debridement with close follow-up solved the problem in this patient. Conclusions Serial debridement with close follow-up enabled to avoid large tissue deficits and complicated reconstruction in the case of NSTI of the chest wall.

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353 Improving Outcomes in Fournier’s Gangrene Using Skin and Soft Tissue Sparing Flap Preservation Surgery: An Alternative Approach to Wide Radical Debridement

Cited by 9 publications

References 0 publications

Effects of Apigenin Treatment on Random Skin Flap Survival in Rats

Effects of Apigenin Treatment on Random Skin Flap Survival in Rats

Incidence and mortality of necrotizing fasciitis in The Netherlands: the impact of group A Streptococcus

A case report of necrotizing soft tissue infection of the chest wall: Effective management with serial debridement

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