Surgical Management of Soft Tissue Infections

Baxter, Charles R.

doi:10.1016/s0039-6109(16)39893-0

Cited by 52 publications

(36 citation statements)

References 16 publications

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“…Several adjuvant studies have been useful as an aid in detecting the condition, e.g., radiographic study, CT scanning, isotope scanning and frozen section biopsy [8]. Gas in soft tissue as seen in our patient is highly suggestive but not pathognomonic [1][2][3]. The hall marks of NF are widespread fascial necrosis with extensive undermining and serosanguinous, often foul smelling exudates.…”

Section: Discussionmentioning

confidence: 93%

“…Various names have been ascribed to this lesion including hospital gangrene, gangrenous or necrotizing erysipelas, hemolytic or acute streptococcal gangrene, suppurative fasciitis, Meleney's gangrene and Fournier's gangrene. The term necrotizing fasciitis was first coined by Wilson in 1952 [1][2][3][4].…”

Section: Discussionmentioning

confidence: 99%

“…The skin necrosis is secondary to thrombosis of the nutrient vessels passing through fascia [1,6,7]. The patient is acutely ill, with low to medium grade fever associated with tachycardia out of proportion to the temperature elevation [3]. Until now, there has been no specific diagnostic method for NF.…”

Section: Discussionmentioning

confidence: 99%

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Necrotizing Fasciitis: An Unusual Presentation

Sasindran

Joseph

2011

Indian J Otolaryngol Head Neck Surg

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Necrotizing fasciitis (NF) is rare but life threatening multimicrobial soft tissue infection characterized by progressive, usually rapid, necrotizing process of the subcutaneous tissues and fascial planes, with resulting skin gangrene and systemic toxicity. The groin, abdomen and extremities are the most frequent sites involved by this disease and it is rarely seen in the head and neck region. NF of the head and neck region has a potentially high morbidity and mortality. Delay in diagnosis leads to poor outcome. Hence early recognition and aggressive management is imperative for successful outcome. Here we present a case of acute onset of cervical necrotizing fasciitis in a young male.Keyword Necrotizing fasciitis Á Soft tissue infections Á Diabetes mellitus Case ReportA 33-year old male presented to the emergency room complaining of painful neck swelling with difficulty in breathing. Patient was apparently alright the previous night and noticed the swelling during the early morning hours. The cervical swelling increased over the next few hours and was brought to the hospital by noon. Patient did not have any associated history of throat pain, trauma, or tooth ache. He was a normotensive and not a diabetic, had family history of diabetes. Examination showed a diffuse swelling of submental and submandibular region with edema of the floor of the mouth with trismus. The skin over the swelling was erythematous, tender and the swelling was fluctuant. Provisionally a diagnosis of Ludwig's angina with submandibular abscess was made. Patient had difficulty in breathing on lying down. A X-ray neck lateral view done else where showed evidence of airway obstruction (Fig. 1). Patient was shifted for CT scan and developed stridor on table. Hence he was immediately rushed to the theatre and an emergency tracheostomy was done. A low tracheostomy was done as none of the landmarks in the neck could be identified (Fig. 2).It was decided to explore the neck on table. A transverse incision was made over the submental region. The whole subcutaneous fat and partly the muscles were found to be necrosed (Fig. 3) and it was foul smelling. A brownish fluid oozed out of the muscle planes and there was no evidence of pus in the submental or submandibular space. Deep cervical fascia was found to be necrosed and the debrided tissues were sent for histopathological examination. Similarly the parapharyngeal spaces were explored on either sides through a separate vertical incision along the sternocleiodomastoid to look for any abscess formation. Necrosed subcutaneous fat from these areas were debrided and a swab was sent for culture sensitivity from these necrosed areas. A dental examination was also done in the same sitting to look for any dental foci. However the oral cavity and oropharynx were normal except for edematous floor of the mouth. The explored areas were left open and antibiotic dressings applied. Blood report showed leukocytosis. His random sugar levels were 350 mg/dl. Glycosylated haemoglobin was 9.5. Patient was started...

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Necrotizing Fasciitis: An Unusual Presentation

Sasindran

Joseph

2011

Indian J Otolaryngol Head Neck Surg

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“…[3][4][5][6][9][10][11][12] The term necrotizing fasciitis (NF) was first coined by Wilson in 1952. 3,6 NF is usually known to occur in the perineum, lower limbs or abdominal wall following surgery or trauma, particularly in individuals with underlying systemic diseases, such as diabetes mellitus, arteriosclerosis, chronic renal failure or malnutrition 1,3,4 NF may affect patients of all ages, without sex or race predilection. 3,6 NF is rarely seen in the head and neck region, 1,6 however, its occurrence is probably more than the reported cases would suggest NF involvement of the scalp and face is less common when compared to the cervical region.…”

Section: Discussionmentioning

confidence: 99%

“…Superficial nerves are damaged, producing the characteristic localized anesthesia. 5,6 Septicemia ensues with systemic toxicity. Necrotizing fasciitis seen commonly seen in the extremities, trunk and perineum.…”

Section: Introductionmentioning

confidence: 99%

Necrotizing Fasciitis of Face in Odontogenic Infection: A Rare Clinical Entity

Vivek¹,

Singh²,

Veena³

et al. 2012

World Journal of Dentistry

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Necrotizing fasciitis is a progressive, life-threatening, bacterial infection of the skin, the subcutaneous tissue and the underlying fascia, in most cases caused by -hemolytic group A Streptococcus. Only early diagnosis and aggressive therapy including broad spectrum antibiotics and surgical intervention can avoid systemic toxicity with a high mortality rate. This disease is commonly known to occur in the lower extremities and trunk, and only rarely in the head and neck region, the face being rarest finding. When located in the face necrotizing fasciitis is associated with severe cosmetic and functional complication due to the invasive nature, infection and often due to the necessary surgical treatment. In the following article, we present the successful diagnosis and management of an isolated facial necrotizing fasciitis as a consequence of odontogenic infection.

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Predictors of Mortality and Limb Loss in Necrotizing Soft Tissue Infections

Anaya

McMahon²,

Nathens³

et al. 2005

Arch Surg

356

305

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Necrotizing soft tissue infections are associated with a high mortality rate. We hypothesize that specific predictors of limb loss and mortality in patients with necrotizing soft tissue infection can be identified on hospital admission.Design: A retrospective cohort study.Setting: A tertiary care center.Patients: Patients with a diagnosis of necrotizing soft tissue infection during a 5-year period (1996)(1997)(1998)(1999)(2000)(2001) were included. Patients were identified with International Classification of Diseases, Ninth Revision hospital discharge diagnosis codes, and diagnosis was confirmed by medical record review.Interventions: Standard current treatment including early and scheduled repeated debridement, broadspectrum antibiotics, and physiologic and nutritional support was given to all patients.Main Outcome Measures: Limb loss and mortality.Results: One hundred sixty-six patients were identified and included in the study. The overall mortality rate

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Surgical Management of Soft Tissue Infections

Cited by 52 publications

References 16 publications

Necrotizing Fasciitis: An Unusual Presentation

Necrotizing Fasciitis: An Unusual Presentation

Necrotizing Fasciitis of Face in Odontogenic Infection: A Rare Clinical Entity

Predictors of Mortality and Limb Loss in Necrotizing Soft Tissue Infections

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