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Postpartum infections
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Prompt surgical resection of the involved tissues is essential for effective management of necrotizing fasciitis. Mortality is 100% in patients treated with antibiotics alone or with incision and drainage only (94). Debridement should extend to where the subcutaneous tissues cannot be separated from the underlying deep fascia or from normal skin. Any tissue that is indurated, edematous, or crepitant, or that does not bleed readily when incised, should be removed (92). More than one surgical debridement may be necessary if subcutaneous necrosis is not arrested. Hyperbaric oxygen is an adjunctive measure and should not substitute for surgical debridement.
Toxic Shock Syndrome and Other Related Severe Infections
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
As mentioned previously, the colonization rate of GAS in the vagina is approximately 0.03% [119]. Table 11.5 illustrates the aggressive of GAS; therefore, when found, GAS should be treated promptly. Although GAS can rapidly disseminate throughout the bloodstream, blood cultures are frequently negative. Obtaining tissue from the infectious source to isolate the bacterium or its virulence factors is often the only reliable laboratory test. Although laboratory values are often nondiagnostic, in the context of a strongly suspected severe soft tissue infection, they can support the diagnosis of necrotizing fasciitis [121]. Table 11.3 illustrates the pertinent laboratory findings associated with invasive GAS infections; particular concern for necrotizing fasciitis should be paid to patients with a white blood cell count >25,000/mL, a hemoglobin level of <11 mg/dL, a serum sodium of <135 mEq/L, a creatinine level of >1.6 mg/dL, and a glucose level of >180 mg/dL [121]. There may be marked hemoconcentration as fluid pours into the area of necrosis, as well as evidence of DIC and septic shock. Hypocalcemia is common as a consequence of the necrotic fat binding to calcium to form soap [121].
Emergency Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Alastair Brookes, Yiu-Che Chan, Rebecca Fish, Fung Joon Foo, Aisling Hogan, Thomas Konig, Aoife Lowery, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Colin Walsh, John Wang, Ting Hway Wong
How is Necrotising Fasciitis Classified?It can be classified as primary/secondary: primary necrotising fasciitis is due to bacterial entry from mild skin trauma.Secondary necrotising fasciitis is due to prior infection (e.g. deep abscess/visceral perforation).Or it can be classified according to microbiological findings14: Type 1: polymicrobial aetiology, including aerobic and anaerobic organismsType 2: caused by group A streptococci (GAS) either alone or in association with staphylococciType 3: monomicrobial infections caused by Clostridium species or Gram-negative bacteriaType 4: fungal aetiology
Necrotizing myositis case report and brief literature study
Published in Acta Clinica Belgica, 2020
Arthur Basso, Filip Moerman, Christophe Ronsmans, Martine Demarche
We distinguish two types of necrotizing fasciitis. Type 1, which is called polymicrobial fasciitis, and type 2, which is called monomicrobial fasciitis. Type 1 necrotizing fasciitis is especially seen among patients with underlying conditions that hamper correct tissue oxygenation, such as diabetes, in post-operative conditions or when a patient suffers from chronic immunosuppression. However, type 2 necrotizing fasciitis is the result of a cutaneous entry point (a wound, a sting, a burn), a muscular tear, or an infection of the throat: nearly always Lancefield group A streptococci are involved; sometimes Staphylococci (Methicillin-resistant and sensible S. aureus), Aeromonas hydrophilia in freshwater and Vibrio vulnificus in seawater can be involved as well. (Table 1)
Acute wound infections management: the ‘Don’ts’ from a multidisciplinary expert panel
Published in Expert Review of Anti-infective Therapy, 2020
Gabriele Sganga, Federico Pea, Domenico Aloj, Silvia Corcione, Marina Pierangeli, Stefania Stefani, Gian Maria Rossolini, Francesco Menichetti
However, the recognition of acute wound infections may be challenging in some circumstances. Necrotizing fasciitis is a life-threatening, rapidly progressive, soft tissue infection that can start at the site of a wound (including a major trauma or a surgical wound). Its delayed recognition is associated with high mortality and morbidity, but diagnosis is challenging. Pain out of proportion is a warning sign of necrotizing fasciitis [20]. Thus, it represents a sign that clinicians should not minimize, even in case of wound without or with minimal signs of infections. Conversely, the lack of pain in a wound with minimal surrounding erythema does not exclude a severe wound infection. As a matter of fact, elderly, frail, and obese patients can present with negligible local signs and nonspecific general signs (such as loss of appetite, malaise, or deterioration of glycemic control in diabetic patients). Importantly, in case of suspected wound infection a complete patient evaluation should be performed, taking into account the presence of systemic signs and symptoms, such as fever, tachycardia, hypotension, and the alteration of serum biomarkers, such as deterioration of renal function, increase in white blood cells count, CPK and C-reactive protein.
Microvascular reconstruction after extensive cervical necrotizing fasciitis: A case series
Published in Acta Oto-Laryngologica Case Reports, 2019
Rajan P. Dang, Joseph P. Bradley, Joseph Zenga, Patrik Pipkorn
Necrotizing fasciitis is a rapidly spreading infection, involving fascia and soft tissue, leading to necrosis of affected tissues and overlying skin. If not promptly recognized and treated, this disease can be fatal in 18–50% of patients [1,2] with higher mortality when the mediastinum is involved. It may affect any area of the body, but it is most common in the extremities, trunk or abdomen following trauma or surgery [3,4]. Necrotizing fasciitis in the head and neck is rare but is well described, most commonly following odontogenic, tonsillar, or pharyngeal infections, surgery, or self-administered injection [5–7]. It is also more frequently seen in patients with co-morbidities such as diabetes mellitus, obesity, hypertension, tobacco use, or immunocompromise [8,9]. The main treatment modality is aggressive surgical debridement with supportive care and antimicrobial therapy [9,10]. Such debridement, however, may lead to significant tissue loss, requiring vascularized reconstruction for optimal post-treatment function. However, specific challenges arise in reconstruction after necrotizing fasciitis, due to surrounding inflammation, tissue edema, and vessel depletion, often severely limiting otherwise optimal reconstructive options. There is a paucity of reports on free tissue reconstruction in the setting of extensive cervical necrotizing fasciitis and the surgical outcomes and prognostic factors remain uncertain [10].