Necrotizing Fasciitis of the Upper Extremity – A Review

Abstract

Necrotizing fasciitis is a soft tissue infection that habitually originates from the fascial sheaths, expands at a volant pace, leads to extensive necrosis of the subcutaneous tissues, and eventually ends up in a life-threatening condition with notably elevated amputation and mortality rates. Factors that induce interruption of skin integrity, such as trauma or intravenous drug use, are the most common inciting events. Specific clinical signs heralding its presence are usually absent in the early stages, often resulting in misdiagnosis. Early recognition, prompt and aggressive surgical debridement, antibiotic use, and supportive care constitute the fundamental principles to lean on for a better prognosis. Necrotizing fasciitis of the upper extremity is relatively rare and consequently holds a limited place in the literature. Only a few studies assess it as a separate entity, with most of them being case reports or small case series. We, therefore, performed a review of the current literature, to assemble the dispersed results of different studies and clarify the various aspects of upper limb necrotizing fasciitis. In this systematic review, we present the epidemiological data, the causative events, the most frequent underlying diseases, the risk factors, the amputation and mortality rates, the pathogenic microorganisms, the clinical characteristics, the diagnostic tools, the medical and surgical management concerning necrotizing fasciitis of the upper limb. Finally, the results indicating its differentiation compared to necrotizing fasciitis of other anatomic sites are remarkably highlighted.

Successfully drug treatment for necrotizing fasciitis caused by Streptococcus pyogenes in 88‐year‐old patient

“…The initial treatment should comprise antibiotics targeting aerobic gram‐positive cocci, gram‐negative rods, and some anaerobes. This treatment lust be readjusted according the results of tissue cultures and sensitivity patterns 9 . Additionally, wound care with hydrogen fiber dressing made of woven fibers of sodium methylcellulose was used to absorb exudate forming a cohesive gel.…”

“…This treatment lust be readjusted according the results of tissue cultures and sensitivity patterns. 9 Additionally, wound care with hydrogen fiber dressing made of woven fibers of sodium methylcellulose was used to absorb exudate forming a cohesive gel. This dressing was non‐adhesive and can be easily removed.…”

Necrotizing Soft-Tissue Infections: A Case-Based Review

“…Often, this is caused by bacterial invasion through the epidermis due to trauma (eg, injection, cut, chronic wound/boil) that compromises skin integrity. 4,5 Rarely, NF will develop in a healthy individual after a minor trauma without a break in the skin barrier. Organisms spread from the subcutaneous tissue along the superficial and deep fascial planes facilitated by bacterial enzymes and toxins.…”

“…Necrotizing fasciitis is characterized by widespread necrosis of the subcutaneous tissue and fascia. Often, this is caused by bacterial invasion through the epidermis due to trauma (eg, injection, cut, chronic wound/boil) that compromises skin integrity 4,5 . Rarely, NF will develop in a healthy individual after a minor trauma without a break in the skin barrier.…”

A Comparison of the Application of Two Different Scoring Systems in a Patient With Upper Limb Necrotizing Fasciitis

“…It has an estimated incidence of 0.24 to 0.4 cases per 100,000 per year in the Western world [ 1 ] and a high mortality rate of 25% to 35% [ 2 ]. Its presentation is relatively rare in the upper limbs, reporting as low as 6% to 27% compared to the lower limbs without a difference in sidedness or gender predilection [ 3 ].…”