Necrotizing fasciitis of the breast in a pregnant woman successfully treated using negative-pressure wound therapy

Abstract

Necrotizing fasciitis (NF) is a rare and rapidly progressive disease involving the skin, subcutaneous tissue, and deep soft tissue. Although NF can occur any part of the body, the breast is an uncommon primary site for NF, and its occurrence in the breast during pregnancy has never previously been reported. Here, we report the case of a healthy 31-year-old pregnant woman who presented with NF of the left breast that was successfully treated with breast-conserving debridement and secondary wound closure using negative-pressure wound therapy.

A rare case of primary necrotising fasciitis of the breast: combined use of hyperbaric oxygen and negative pressure wound therapy to conserve the breast. Review of literature

“…The first case of NF of the breast was described by Shah in 2001 , and only 11 cases of PNFB (i.e. with no previous trauma or intervention) have been reported in the literature so far (Table ); among these, only 5 cases without any associated comorbidity are reported . The current case is the first described Italian case of PNFB in otherwise healthy patients, the second in Europe and the sixth reported in the English literature (Table ).…”

“…As far as NF affecting the breast is concerned, the mastectomy has been reported to be the most common surgical procedure in the published literature (Table ), but the most effective treatment is not well established because of the lack of a large case series. In this context, some authors have suggested breast conservative treatment , and only one paper reported about wound management using NPWT (Table ).…”

“…It is even more unusual as a primary disease of the breast, with no previous invasive procedure or other comorbid conditions. To the best of our knowledge, only 11 cases of spontaneous necrotising infection of the breast have been reported in the literature , and 5 of these were otherwise healthy women . Mastectomy is reported to be the main treatment in the published literature.…”

Rare postpartum primary necrotizing fasciitis of the breast following mastectomy: case report

“…Although surgical treatment with mastectomy adopted in this case has been performed in other cases 4,7,9,11,13 , there have been reports of successful treatment with conservative surgery 3,8,12,14,15 and even without surgery 10 . Lee et al 10 reported a case of NF of the breast in a pregnant woman successfully treated using negative-pressure wound therapy.…”

“…Only a few cases of necrotizing fasciitis in the breast [3][4][5][7][8][9][10][11][12][13][14][15] have been reported in the literature; and due to the high mortality rate, early recognition and surgical debridement are of absolute importance. Emergency surgical debridement of the affected tissues is the primary management modality for NF.…”