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

Abstract

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.

Síndrome de Fournier: 10 anos de avaliação

“…Hy poxia and tissue ischemia affect metabolism and lead to increased dissemination of facultative microorganisms that use the cells' energy sources. The resultant gases (i.e., hydrogen and nitrogen) are responsible for the crepitation that occurs in the first 48 to 72 hours of infection [3][4][5] . In 1884, French venereologist Jean Alfred Fournier 6 described 5 cases of patients with idiopathic gangrene of the penis and scrotum.…”

Skin and Soft Tissue Infection as a Complication of Varicella Infection Ended up in Using Intravenous Immunoglobulin Instead of Surgical Debridement: A Case Report and Short Review of Literature

“…In Press(In Press):e66108. and pain may be presented before cutaneous manifestations such as rash or blisters (9). However, some patients may not have visible skin lesions, similar to the current case (10).…”

Effectiveness of Intralesional Bleomycin Sclerotherapy for Lymphangioma in Children

“…These side effects appear common and have been recorded in previous studies [17,18] . These side effects were mostly reported after patients had been discharged from the study.…”