Management of necrotizing fasciitis in diabetic patients

Gürlek, Ali; Fırat, Cemal; Öztürk, Ayşe Ersöz; Alaybeyoğlu, Nezih; Fariz, Alpay; Aslan, Serkan

doi:10.1016/j.jdiacomp.2006.08.006

Cited by 24 publications

(21 citation statements)

References 22 publications

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“…Patients with DM appear to be particularly at risk, representing over 70% of cases in one large review [46]. The other co-morbidities include obesity, alcohol abuse, immune-deficiency, chronic renal failure, liver cirrhosis, hypertension, peripheral vascular disease and age above 60 years [1,2].…”

Section: Resultsmentioning

confidence: 99%

Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs

et al. 2011

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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.

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Section: Resultsmentioning

confidence: 99%

Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs

et al. 2011

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“…Although CoNS are part of the normal skin flora, they flourish in the untreated gangrenous tissue and become pathogenic by releasing virulence factors from involved tissues. Thus, CoNS can easily cause fulminant sepsis in diabetic patients with necrotizing faciitis [12,19].…”

Section: Discussionmentioning

confidence: 99%

Monomicrobial necrotizing fasciitis caused by coagulase-negative Staphylococci and methicillin-resistant Staphylococcus aureus

Shen

Huang

Cheng

et al. 2011

Eur J Orthop Surg Traumatol

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“…Diabetes mellitus results in peripheral vasoocclusion and ''sugar-coated capillaries'' limit the blood supply to the superficial and deep structures. Subsequent invasion of the bloodstream by virulence factors released from gangrenous tissues can easily cause fulminant sepsis in patients with diabetes with necrotizing faciitis [4,8].…”

Section: Discussionmentioning

confidence: 99%

Case Reports: Fatal Necrotizing Fasciitis Caused by Aeromonas sobria in Two Diabetic Patients

Tsai

Huang

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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We report two rare cases of Aeromonas sobria necrotizing fasciitis with sepsis in patients with diabetes. In both cases, immediate fasciotomy was performed and appropriate empiric antimicrobial therapy and intensive care were administered. However, the two patients died on Day 2 and Day 11, respectively, after admission as a result of multiple organ failure. When patients present with a rapid onset of skin necrosis and progressive sepsis, an Aeromonas sobria infection or Vibrio infection should be considered in the differential diagnosis.

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Management of necrotizing fasciitis in diabetic patients

Cited by 24 publications

References 22 publications

Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs

Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs

Monomicrobial necrotizing fasciitis caused by coagulase-negative Staphylococci and methicillin-resistant Staphylococcus aureus

Case Reports: Fatal Necrotizing Fasciitis Caused by Aeromonas sobria in Two Diabetic Patients

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