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Nichkaode P, Haval S. Unmasking the Silent Threat: Meleney's Synergistic Gangrene in a Healthy Young Woman Without Predisposing Factors. Cureus 2024; 16:e63849. [PMID: 38974393 PMCID: PMC11226221 DOI: 10.7759/cureus.63849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 07/09/2024] Open
Abstract
A rare rapidly-spreading necrotizing infection of the skin and soft tissues, Meleney's synergistic gangrene is characterized by a synergistic infection with both staphylococci and microaerophilic streptococci. This report presents a case of Meleney's synergistic gangrene in a young female patient with no comorbidities and no surgical history who was initially misdiagnosed as a case of perineal abscess and later after the culture report and course of the spread of infection, it was diagnosed as a case of Meleney's synergistic gangrene. The patient underwent serial debridements with a combination of broad-spectrum antibiotic cover followed by secondary closure of the wound and the patient was followed up after three months post-discharge and showed full recovery with no recurrence of infection.
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Affiliation(s)
| | - Shriya Haval
- General Surgery, Dr. D. Y. Patil Vidyapeeth, Pune, IND
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2
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Alzetani S, Harden S, Alzetani A. An unexpected case of thoracic necrotising fasciitis. BMJ Case Rep 2024; 17:e257946. [PMID: 38296508 PMCID: PMC10831425 DOI: 10.1136/bcr-2023-257946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2024] Open
Abstract
Necrotising fasciitis (NF) is a life-threatening bacterial infection characterised by rapid tissue destruction, which can have severe consequences if not recognised early and treated promptly. It is most commonly caused by group A streptococcus entering the body through breaks in the skin. This case report describes a patient who presented with systemic signs of infection, including right axillary pain, following a recent intramuscular injection. Clinical examination and radiological findings were consistent with NF, and surgical exploration confirmed the diagnosis of thoracic NF. The patient underwent extensive surgical debridement, intensive care management and subsequent reconstructive surgery. This report highlights the importance of early recognition of NF and that this condition is not limited to the limbs but may also affect the torso. It employs consideration of all portals of potential bacterial entry that may prompt a differential of NF through thorough history taking. This case encourages healthcare professionals to maintain awareness of skin infections as a potential though rare complication of procedures such as injections hence the continued value of aseptic techniques to minimise risk. Finally, it emphasises that prompt diagnosis, appropriate antibiotic therapy and immediate surgical intervention remain crucial in managing NF and improving patient outcomes.
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Affiliation(s)
- Sarah Alzetani
- Salisbury District Hospital NHS Foundation Trust, Salisbury, UK
| | - Stephen Harden
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Aiman Alzetani
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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3
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Kjaldgaard L, Cristall N, Gawaziuk JP, Kohja Z, Logsetty S. Predictors of Mortality in Patients With Necrotizing Fasciitis: A Literature Review and Multivariate Analysis. Plast Surg (Oakv) 2023; 31:221-228. [PMID: 37654537 PMCID: PMC10467438 DOI: 10.1177/22925503211034830] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/22/2021] [Indexed: 09/02/2023] Open
Abstract
Background Necrotizing fasciitis (NF) is a life-threatening infectious disease that can result in significant morbidity and mortality. Previously identified factors have not been verified in a large population. The objective of this study is to further examine the relationship of patient factors in NF mortality. Methods This study is a retrospective review on patients ≥18 years old diagnosed with NF at the provincial referral centres from 2004 to 2016. The following data were examined: demographics, comorbidities, laboratory values, length of stay, and inhospital mortality. Results Three hundred forty patients satisfied the inclusion criteria: 297 survived and were discharged, 43 died in hospital. In multivariate analysis, a prognostic model for NF mortality identified age >60 years, elevated creatinine, abnormal blood platelets, and group A β-hemolytic Streptococcus (GABS) infection. Conclusions Multiple factors were associated with mortality in NF. The strongest univariate association with mortality was age >60 years. In addition, a history of hypertension and/or dyslipidemia, renal disease, and the presence of GABS contributed to a predictive model for inhospital NF mortality.
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Affiliation(s)
- Lindsey Kjaldgaard
- College of Medicine, Med II Research Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nora Cristall
- Manitoba Firefighters Burn Unit, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Justin P. Gawaziuk
- Manitoba Firefighters Burn Unit, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Zeenib Kohja
- College of Medicine, BSc (Med Research Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sarvesh Logsetty
- Manitoba Firefighters Burn Unit, Health Sciences Centre, Winnipeg, Manitoba, Canada
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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4
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Elkhoury D, Quick S, Kalloo AE, Gorantla VR. Necrotizing Fasciitis Secondary to Mycotic Femoral Aneurysm: A Narrative Review of Diagnosis and Management Strategies. Cureus 2023; 15:e37586. [PMID: 37193468 PMCID: PMC10183231 DOI: 10.7759/cureus.37586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 05/18/2023] Open
Abstract
This comprehensive literature review aims to investigate the pathophysiology, clinical manifestations, diagnostic tools, and treatment options for necrotizing fasciitis secondary to mycotic femoral aneurysm, a rare and potentially lethal infectious disease, particularly focusing on any changes throughout the years for an update of the current literature. The pathophysiology of necrotizing fasciitis and mycotic femoral aneurysms is a complex and multifaceted process that typically involves bacterial infections as a common precursor to the onset of these conditions. This can potentially lead to the formation of an aneurysm. As the infection progresses, it can spread from the aneurysm to surrounding soft tissues, resulting in significant tissue damage, obstructed blood circulation, and ultimately culminating in cell death and necrosis. Clinical manifestations of these conditions are diverse and encompass a range of symptoms, such as fever, localized pain, inflammation, skin changes, and other indicators. It is worth noting that skin color can influence the presentation of these conditions, and in patients with diverse skin tones, certain symptoms may be less noticeable due to a lack of visible discoloration. Imaging, laboratory findings, and clinical presentation are important components of the diagnosis of mycotic aneurysms. CT scans are a reliable tool for identifying specific features of infected femoral aneurysms, and elevated inflammatory laboratory results can also suggest a mycotic aneurysm. In the case of necrotizing fasciitis, clinicians should maintain a high level of suspicion as this condition is rare but life-threatening. Clinicians will need to view the big picture when an infection may be caused by necrotizing fasciitis, considering CT imaging, blood work, and clinical presentation of the patient without delaying surgical intervention. By incorporating the diagnostic tools and treatment options outlined in this review, healthcare professionals can improve patient outcomes and reduce the burden of this rare and potentially lethal infectious disease.
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Affiliation(s)
- David Elkhoury
- Anatomical Sciences, St. George's University School of Medicine, St. George, GRD
| | - Sarah Quick
- Surgery, St. George's University School of Medicine, St. George, GRD
| | - Amy E Kalloo
- Clinical Sciences, St. George's University, St. George, GRD
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5
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Escudero-Sepúlveda AF, Cala-Duran JC, Belén-Jurado M, Tomasone SE, Carlino-Currenti VM, Abularach-Borda R, Roccuzzo C, Puche-Burgos JFDJ, Acosta-Maestre JE. Conceptos para la identificación y abordaje de la gangrena de Fournier. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. La gangrena de Fournier es una fasciitis necrosante fulminante y progresiva, de origen infeccioso sinérgico polimicrobiano, que afecta las regiones perianal, perineal, genital y abdominal. Su incidencia es mayor en hombres, la edad promedio de presentación reportada está en los 54,7 ± 15,6 años, su mortalidad es del 3-67 %, aunque hay estudios que informan una mortalidad en hombres del 7,5 % y en las mujeres del 12,8 %.
Métodos. Se hizo una revisión de la literatura en las bases de datos y fuentes de información PubMed, Scielo y Google Scholar, publicados entre 1950 y 2018, utilizando términos como "fournier gangrene", "fasciitis, necrotizing”, “wound infection”, "therapy"[subheading] y “GRADE approach". Se realizó una segunda revisión para artículos latinoamericanos en español hasta 2020 usando las mismas fuentes y palabras claves.
Resultados. Se seleccionaron artículos que reportaron definiciones, datos históricos, actualizaciones en diagnóstico y terapéutica para hacer una revisión actualizada. Para el uso de las imágenes se solicitó consentimiento informado.
Conclusión. La gangrena de Fournier continúa siendo una emergencia quirúrgica potencialmente letal. Gracias a las investigaciones realizadas se ha avanzado en su tratamiento, mejorando los resultados. Es importante analizar los factores de riesgo en cada paciente y su etiología para establecer el tratamiento más adecuado.
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6
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Dienemann L, Betz T, Töpel I, Steinbauer M. Persönliche Wahrnehmung der CoV-2-Pandemie und reales Risiko einer nekrotisierenden Fasziitis. GEFÄSSCHIRURGIE 2022; 27:51-54. [PMID: 34975232 PMCID: PMC8713545 DOI: 10.1007/s00772-021-00830-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Lucas Dienemann
- Klinik für Gefäßchirurgie, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049 Regensburg, Deutschland
| | - Thomas Betz
- Klinik für Gefäßchirurgie, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049 Regensburg, Deutschland
| | - Ingolf Töpel
- Klinik für Gefäßchirurgie, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049 Regensburg, Deutschland
| | - Markus Steinbauer
- Klinik für Gefäßchirurgie, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049 Regensburg, Deutschland
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7
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Somasundaram J, Wallace DL, Cartotto R, Rogers AD. Flap coverage for necrotising soft tissue infections: A systematic review. Burns 2021; 47:1608-1620. [PMID: 34172327 DOI: 10.1016/j.burns.2021.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/05/2020] [Accepted: 01/20/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Necrotising soft tissue infections (NSTI) are destructive and often life-threatening infections of the skin and soft tissue, necessitating prompt recognition and aggressive medical and surgical treatment. After debridement, the aim of surgical closure and reconstruction is to minimize disability and optimize appearance. Although skin grafting may fulfil this role, techniques higher on the reconstructive ladder, including local, regional and free flaps, are sometimes undertaken. This systematic review sought to determine the circumstances when this is true, which flaps were most commonly employed, and for which anatomical areas. METHODS A systematic review of the literature was conducted utilising electronic databases (Medline, Embase, Cochrane Library). Full text studies of flaps used for the management of NSTI's (including Necrotising Fasciitis and Fournier Gangrene) were included. The web-based program 'Covidence' facilitated storage of references and data management. Data obtained in the search included reference details (journal, date and title), the study design, the purpose of the study, the study findings, number of patients with NSTI included, the anatomical areas of NSTI involved, the types of flaps used, and the complication rate. RESULTS After screening 4555 references, 501 full text manuscripts were assessed for eligibility after duplicates and irrelevant studies were excluded. 230 full text manuscripts discussed the use of 888 flap closures in the context of NSTI in 733 patients; the majority of these were case series published in the last 20 years in a large variety of journals. Reconstruction of the perineum following Fournier's gangrene accounted for the majority of the reported flaps (58.6%). Free flaps were used infrequently (8%), whereas loco-regional muscle flaps (18%) and loco-regional fasciocutaneous flaps (71%) were employed more often. The reported rate of partial or complete flap loss was 3.3%. CONCLUSION Complex skin and soft tissue defects from NSTIs, not amenable to skin grafting, can be more effectively and durably covered using a spectrum of flaps. This systematic review highlights the important contribution that the plastic surgeon makes as an integral member of multidisciplinary teams managing these patients.
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Affiliation(s)
- J Somasundaram
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - D L Wallace
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - R Cartotto
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - A D Rogers
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Canada.
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8
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Abstract
Acute uncomplicated appendicitis is a common surgical disease that has been well-studied, and its overall mortality has decreased over time. However, delay in treatment can be associated with rare complications such as necrotizing fasciitis, which carries a high mortality rate, and bladder perforation. We present such a case in an 81-year-old female with no significant surgical history who presented to the emergency department with four days of abdominal pain. A CT scan revealed extensive subcutaneous air in the abdominal wall, an inflamed appendix, and a periappendiceal abscess. During subsequent exploratory laparotomy, she was also found to have bladder perforation. She underwent debridement of necrotic tissue of the abdominal wall, appendectomy, drainage of periappendiceal abscess, and bladder perforation repair. She died of septic shock on post-operative day 19, due to gross spillage of urine into the abdomen and ongoing necrotizing fasciitis. Acute perforated appendicitis can lead to rare and fatal complications. Our case presents such a patient with a poor outcome. In approaching a patient with signs of peritonitis, differential diagnoses must remain broad to include late complications such as abscess formation, soft tissue infection, and perforation of surrounding structures.
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Affiliation(s)
- John Oh
- Emergency Department, Kent Hospital, Warwick, USA
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9
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Mascagni D, Eberspacher C, Mascagni P, Arezzo A, Selvaggi F, Sturiale A, Milito G, Naldini G. From high volume to "zero" proctology: Italian experience in the COVID era. Int J Colorectal Dis 2020; 35:1777-1780. [PMID: 32468103 PMCID: PMC7255907 DOI: 10.1007/s00384-020-03622-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic hit Italy early and strongly, challenging the whole health care system. Proctological patients and surgeons are experiencing a previously unseen change in care with unknown repercussion. Here we discuss the proctological experience of 4 Italian hospitals during the COVID-19 pandemic. METHODS Following remote brainstorming, the authors summarised their experience in managing proctological patients during the COVID-19 pandemics and put forward some practical observations to further investigate. RESULTS The 4 hospitals shifted from a high-volume proctological activity to almost "zero" visits and surgery. Every patient accessing the hospital must respect a specific COVID-19 protocol. Proctological patients can be stratified based on presentation and management considerations into (1) neoplastic patients, the only allowed to be surgically treated, (2) the ones requiring urgent care, operated only in highly selected cases and (3) the stable, already known patients, managed remotely. Changes in the clinical management of the proctological disease are presented together with some considerations to be explored. CONCLUSIONS In the absence of scientific evidence, these practical considerations may be valuable to proctological surgeons starting to face the COVID-19 pandemics. Beside the more clinical considerations, this crisis produced unexpected consequences such as an improvement of the therapeutic alliance and a shift towards telemedicine that may be worth exploring also in the post-COVID-19 era.
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Affiliation(s)
- Domenico Mascagni
- Department of Surgical Sciences, Policlinico Umberto I, “Sapienza” University of Rome, Viale Regina Elena 324, 00100 Rome, Italy
| | - Chiara Eberspacher
- Department of Surgical Sciences, Policlinico Umberto I, “Sapienza” University of Rome, Viale Regina Elena 324, 00100 Rome, Italy
| | - Pietro Mascagni
- IHU Strasbourg – Institute of Image-Guided Surgery, Strasbourg, France
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Francesco Selvaggi
- Colorectal Surgery, Department of Advanced Medical and Surgical Sciences, Università della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Alessandro Sturiale
- Proctological and Perineal Surgical Unit, Universitary Hospital of Pisa, Pisa, Italy
| | | | - Gabriele Naldini
- Proctological and Perineal Surgical Unit, Universitary Hospital of Pisa, Pisa, Italy
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10
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Kim YH, Ha JH, Kim JT, Kim SW. Managing necrotising fasciitis to reduce mortality and increase limb salvage. J Wound Care 2018; 27:S20-S27. [DOI: 10.12968/jowc.2018.27.sup9a.s20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Youn Hwan Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Jeong Hyun Ha
- Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul National University, Seoul National University Hospital, Seoul, Korea
| | - Jeong Tae Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Sang Wha Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul National University, Seoul National University Hospital, Seoul, Korea
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11
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Brengard-Bresler T, De Runz A, Bourhis F, Mezzine H, Khairallah G, Younes M, Brix M, Simon E. [Postoperative quality of life of patients with a bacterial necrotizing dermis-hypodermitis or necrotizing fasciitis, a ten-year study]. ANN CHIR PLAST ESTH 2018; 62:31-44. [PMID: 26946930 DOI: 10.1016/j.anplas.2016.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 02/02/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Bacterial necrotizing dermis-hypodermitis and necrotizing fasciitis (BNDH-NF) are serious life-threatening soft-tissue infections. The object is to evaluate the quality of life (QOL) of patients who have been operated in our plastic surgery departement. PATIENTS AND METHODS This is a retrospective study of cases who have been treated at Nancy University Hospital between 2005 and 2014. We analyzed the perioperative data (demographic, clinical, bacteriological), the surgical data (excision, reconstruction) and the follow up data (consequences, mortality). The quality of life was assessed by the Short-Form 36 score, and the patients' satisfaction was assessed by a four-level scale. RESULTS We analyzed 23 patients with an average age of 60 years (28-84 years). The main comorbidities were diabetes (43 %) and obesity (39 %). The average number of surgical excision was about 1.9 (1-5) and the average excised body surface area was about 5 % (1-16 %). The short-term mortality was about 17 %. The mortality rate has been statistically correlated with the surgically excised body surface area (short-term 95 days: P=0.02; and long-term: P=0.003). The statistical analysis has shown a strong relative linear relationship between number of surgical excision and the physical score of QOL (P<0.001), between number of surgical excision and mental score of QOL (P=0.032), and between age and physical score of QOL (P≤0.021). The statistical analysis has also shown a strong relative linear relationship between E. coli infections and physical score of QOL (P=0.01). The percentage of patients' satisfaction in our study was evaluated at 86 %. CONCLUSION We have found that multiple surgical excisions, an advanced age of patients and E. coli infections have been associated with poor QOL. The mortality rate increased in relation with the importance of excised body surface. In spite of the gravity of these infections, our patients were satisfied of their treatment.
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Affiliation(s)
- T Brengard-Bresler
- Service de chirurgie maxillofaciale, plastique, reconstructrice et esthétique, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France; Faculté de médecine, université de Lorraine, 54000 Nancy, France.
| | - A De Runz
- Service de chirurgie maxillofaciale, plastique, reconstructrice et esthétique, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France; Faculté de médecine, université de Lorraine, 54000 Nancy, France
| | - F Bourhis
- Mapi Group, Health Economics and Outcomes Research, 41, rue des Trois-Fontanot, 92000 Nanterre, France
| | - H Mezzine
- Service de chirurgie maxillofaciale, plastique, reconstructrice et esthétique, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France; Faculté de médecine, université de Lorraine, 54000 Nancy, France
| | - G Khairallah
- Service de chirurgie maxillofaciale, plastique, reconstructrice et esthétique, CHR de Metz-Thionville, 1, allée du Château, 57085 Metz, France
| | - M Younes
- Service de chirurgie maxillofaciale, plastique, reconstructrice et esthétique, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France; Faculté de médecine, université de Lorraine, 54000 Nancy, France
| | - M Brix
- Service de chirurgie maxillofaciale, plastique, reconstructrice et esthétique, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France; Faculté de médecine, université de Lorraine, 54000 Nancy, France
| | - E Simon
- Service de chirurgie maxillofaciale, plastique, reconstructrice et esthétique, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France; Faculté de médecine, université de Lorraine, 54000 Nancy, France
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12
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Chiang I, Chang S, Wang C. Management of necrotising fasciitis secondary to abdominal liposuction using a combination of surgery, hyperbaric oxygen and negative pressure wound therapy in a patient with burn scars. Int Wound J 2017; 14:989-992. [PMID: 28414861 PMCID: PMC7949744 DOI: 10.1111/iwj.12745] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 03/04/2017] [Indexed: 11/28/2022] Open
Abstract
Liposuction is the one of the most frequently performed cosmetic operations and usually has an easy recovery, with a reportedly low overall complication rate. Here, we report the case of a 60-year-old woman with type II diabetes mellitus and a previous burn injury of the abdomen who underwent abdominal liposuction and subsequently developed necrotising fasciitis. Following radical debridement, systemic antibiotic administration, negative pressure wound therapy and hyperbaric oxygen therapy, the wound healed completely. This case demonstrates the success of the combination treatment and highlights the need for clinicians to be aware of the risk of serious complications in selected patients.
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Affiliation(s)
- I‐Han Chiang
- Division of Plastic and Reconstructive Surgery, Department of SurgeryTri‐Service General Hospital, National Defense Medical CenterTaipeiTaiwan
| | - Shun‐Cheng Chang
- Division of Plastic and Reconstructive Surgery, Department of SurgeryHyperbaric Oxygen Therapy Center, Shuang-Ho HospitalTaipeiTaiwan Republic of China
- Department of Surgery, School of MedicineCollege of Medicine, Taipei Medical UniversityTaipeiTaiwan Republic of China
| | - Chih‐Hsin Wang
- Division of Plastic and Reconstructive Surgery, Department of SurgeryTri‐Service General Hospital, National Defense Medical CenterTaipeiTaiwan
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13
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Zhao T, Chang L, Zhang B, Lu M, Wang X, Orgah JO, Wang Y, Tian X, Yang J, Fan G, Zhang B, Zhu Y. Specific Combination of Salvianolic Acids As Core Active Ingredients of Danhong Injection for Treatment of Arterial Thrombosis and Its Derived Dry Gangrene. Front Pharmacol 2017; 8:361. [PMID: 28659797 PMCID: PMC5468438 DOI: 10.3389/fphar.2017.00361] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/26/2017] [Indexed: 01/03/2023] Open
Abstract
Although single-targeting anti-platelet agents are used extensively in clinics, their limitations in resistance and bleeding have started a trend of combination therapy. Danhong injection (DHI) is a widely prescribed injection medicine for cardiovascular and cerebrovascular diseases in China. However, its precise clinical efficacy and functional components remain unexplored. In this study, we investigated the anti-thrombotic role and its chemical basis of DHI. In a photochemically-induced thrombosis model, DHI effectively dissolved thrombus and ameliorated its derived dry gangrene. DHI inhibited multiple GPCR agonists-induced platelet adhesion, aggregation and downstream Ca2+ and cAMP signaling pathways. A functional screen of DHI library identified its major active components as a cluster of seven salvianolic acids. A combination of salvianolic acid A and C synergistically inhibited platelet aggregation in vitro while salvianolic acid B antagonized this effect. Our study revealed the anti-thrombotic activity of DHI. The multi-targeting mechanism of DHI proves the effectiveness of a natural anti-thrombotic combination therapy. The identification of salvianolic acids as a core anti-thrombotic activity of DHI and the discovery that their different combinations could either synergistically or antagonistically provide a better guidance for safer clinical application and paves the way for further development of DHI.
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Affiliation(s)
- Tiechan Zhao
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese MedicineTianjin, China.,Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology and MedicineTianjin, China
| | - Lianying Chang
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese MedicineTianjin, China.,Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology and MedicineTianjin, China
| | - Boyong Zhang
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese MedicineTianjin, China.,Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology and MedicineTianjin, China
| | - Ming Lu
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese MedicineTianjin, China.,Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology and MedicineTianjin, China
| | - Xiaoyi Wang
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese MedicineTianjin, China.,Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology and MedicineTianjin, China
| | - John O Orgah
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese MedicineTianjin, China.,Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology and MedicineTianjin, China
| | - Yuefei Wang
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese MedicineTianjin, China.,Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology and MedicineTianjin, China
| | - Xiaoxuan Tian
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese MedicineTianjin, China.,Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology and MedicineTianjin, China
| | - Jing Yang
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese MedicineTianjin, China.,Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology and MedicineTianjin, China
| | - Guanwei Fan
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese MedicineTianjin, China.,Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology and MedicineTianjin, China
| | - Boli Zhang
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese MedicineTianjin, China.,Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology and MedicineTianjin, China
| | - Yan Zhu
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese MedicineTianjin, China.,Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology and MedicineTianjin, China.,Tufts Medical Center, Molecular Cardiology Research Institute, Tufts University School of MedicineBoston, MA, United States
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14
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Deng W, Boey J, Chen B, Byun S, Lew E, Liang Z, Armstrong DG. Platelet-rich plasma, bilayered acellular matrix grafting and negative pressure wound therapy in diabetic foot infection. J Wound Care 2017; 25:393-7. [PMID: 27410393 DOI: 10.12968/jowc.2016.25.7.393] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
UNLABELLED Management and treatment of acute severe diabetic foot disease in patients with suboptimal glycaemic control is a critical issue in wound repair. This paper discusses the clinical efficacy of an aggressive surgical intervention combined with targeted use of regenerative medical therapies in limb preservation. Negative pressure wound therapy (NPWT), platelet-rich plasma (PRP), bilayered acellular matrix grafting and split-thickness skin grafting were combined to treat a patient with diabetes, foot necrotising fasciitis and gaseous gangrene. The wound was completely healed. The clinical outcome revealed that a multi-intervention strategy could be effective for large necrotising fasciitis wounds. Early clinical observation, suggests aggresive surgical intervention preserving intact tissue and targeted use of new regenerative technologies can lead to preservation of a limb. DECLARATION OF INTEREST The authors have received no financial support for the material presented in this study outside of the scope of standard patient care reimbursement. This work was supported by the National Natural Science Foundation of China (NO. 81500596) awarded to Dr Wuquan Deng.
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Affiliation(s)
- W Deng
- Department of Endocrinology, Diabetic Foot Center, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - J Boey
- Department of Podiatry, Singapore General Hospital, Singapore
| | - B Chen
- Department of Endocrinology, Diabetic Foot Center, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - S Byun
- Department of Surgery, Southern Arizona Limb Salvage Alliance (SALSA), University of Arizona Health Sciences Center, Tucson, Arizona, USA
| | - E Lew
- Department of Surgery, Southern Arizona Limb Salvage Alliance (SALSA), University of Arizona Health Sciences Center, Tucson, Arizona, USA
| | - Z Liang
- Department of Endocrinology, Diabetic Foot Center, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - D G Armstrong
- Department of Surgery, Southern Arizona Limb Salvage Alliance (SALSA), University of Arizona Health Sciences Center, Tucson, Arizona, USA
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15
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Kiat HJ, En Natalie YH, Fatimah L. Necrotizing Fasciitis: How Reliable are the Cutaneous Signs? J Emerg Trauma Shock 2017; 10:205-210. [PMID: 29097860 PMCID: PMC5663140 DOI: 10.4103/jets.jets_42_17] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Necrotizing fasciitis (NF) is a surgical emergency. It is often aggressive and characterized by the rapidly progressive inflammatory infection of the fascia that causes extensive necrosis of the subcutaneous tissue and fascia, relatively sparing the muscle and skin tissue. As the disease progresses, thrombosis of the affected cutaneous perforators subsequently devascularizes the overlying skin. The course indeed can be a fulminant one. The diagnosis of NF, especially in the early stages, is extremely challenging, and it can be very close in presentation to other skin and subcutaneous tissue infections. The primary site of the pathology is the deep fascia. Necrosis of the tissues and fascia may manifest as erythema without sharp margins, swelling, warmth, shiny, and exquisitely tender areas. Pain out of proportion to physical examination findings may be observed. The subcutaneous tissue may be firm and indurated such that the underlying muscle groups cannot be distinctly palpated. Eventually, as the overlying skin is stripped of its blood supply, skin necrosis ensues and hemorrhagic bullae form. Bacteremia and sepsis invariably develop when the infection is well established. This paper discusses some of issues related to the cutaneous signs found in NF and also provides a review the current, available literature on the subject matter.
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Affiliation(s)
- Ho Jun Kiat
- Yong Loo Lin Medical School, National University of, Singapore
| | | | - Lateef Fatimah
- Yong Loo Lin Medical School, National University of, Singapore.,Senior Consultant, Department of Emergency Medicine, Singapore General Hospital, Associate Professor, Duke NUS Graduate Medical School, Singapore
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16
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van Stigt SFL, de Vries J, Bijker JB, Mollen RMHG, Hekma EJ, Lemson SM, Tan ECTH. Review of 58 patients with necrotizing fasciitis in the Netherlands. World J Emerg Surg 2016; 11:21. [PMID: 27239222 PMCID: PMC4884415 DOI: 10.1186/s13017-016-0080-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 05/23/2016] [Indexed: 12/05/2022] Open
Abstract
Background Necrotizing fasciitis is a rare, life threatening soft tissue infection, primarily involving the fascia and subcutaneous tissue. In a large cohort of patients presenting with Necrotizing fasciitis in the Netherlands we analysed all available data to determine the causative pathogens and describe clinical management and outcome. Methods We conducted a retrospective, multicentre cohort study of patients with a necrotizing fasciitis between January 2003 and December 2013 in an university medical hospital and three teaching hospitals in the Netherlands. We only included patients who stayed at the Intensive Care Unit for at least one day. Results Fifty-eight patients were included. The mortality rate among those patients was 29.3 %. The central part of the body was affected in 28 patients (48.3 %) and in 21 patients (36.2 %) one of the extremities. Most common comorbidity was cardio vascular diseases in 39.7 %. Thirty-nine patients (67.2 %) were operated within 24 h after presentation. We found a type 1 necrotizing fasciitis in 35 patients (60.3 %) and a type 2 in 23 patients (39.7 %). Conclusions Our study, which is the largest study in Europe, reaffirmed that Necrotizing fasciitis is a life threatening disease with a high mortality. Early diagnosis and adequate treatment are necessary to improve the clinical outcome. Clinical awareness off necrotizing fasciitis remains pivotal.
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Affiliation(s)
- Sander F L van Stigt
- Department of Surgery, Traumasurgery Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Janneke de Vries
- Department of Medical Microbiology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Jilles B Bijker
- Department of Anesthesiology, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands
| | - Roland M H G Mollen
- Department of Surgery, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands
| | - Edo J Hekma
- Department of Surgery, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands
| | - Susan M Lemson
- Department of Surgery, Slingeland Hospital, Kruisbergseweg 25, 7009 BL Doetinchem, The Netherlands
| | - Edward C T H Tan
- Department of Surgery, Traumasurgery Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands
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17
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Hua C, Sbidian E, Hemery F, Decousser JW, Bosc R, Amathieu R, Rahmouni A, Wolkenstein P, Valeyrie-Allanore L, Brun-Buisson C, de Prost N, Chosidow O. Prognostic factors in necrotizing soft-tissue infections (NSTI): A cohort study. J Am Acad Dermatol 2015; 73:1006-12.e8. [PMID: 26412163 DOI: 10.1016/j.jaad.2015.08.054] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/16/2015] [Accepted: 08/19/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Necrotizing soft-tissue infection (NSTI) is uncommon but life-threatening. A recent meta-analysis estimated the overall mortality at 23.5%. OBJECTIVE We sought to identify risk factors associated with mortality in a cohort of patients with NSTI in a tertiary care center. METHODS We identified 512 patients with NSTI between 1996 and 2012 in the national hospital database Program for Medicalization of Information Systems and examined risk factors of mortality with NSTI by univariate and multivariate analysis. RESULTS We included 109 patients with a confirmed diagnosis of NSTI; 31 (28%) died at a median follow-up of 274 days (range 2-6135 days). On multivariate analysis, independent risk factors of mortality were age older than 75 years (hazard ratio [HR] 4.4, 95% confidence interval [CI] 1.8-10.3), multifocal NSTI (HR 5.9, 95% CI 1.9-18.5), severe peripheral vascular disease (HR 5.1, 95% CI 1.5-17.0), hospital-acquired infection (HR 3.9, 95% CI 1.4-10.7), severe sepsis (HR 7.4, 95% CI 1.7-33.1), and septic shock on hospital admission (HR 13.9, 95% CI 3.8-50.4). LIMITATIONS This was a retrospective cohort, which disallows a precise record of the delay between diagnosis and surgery. CONCLUSION Our findings for this robust cohort of patients with a definite diagnosis of NSTI could help clinicians stratify NSTI severity at clinical course onset.
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Affiliation(s)
- Camille Hua
- Département de Dermatologie, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Emilie Sbidian
- Département de Dermatologie, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France; Pôle Recherche Clinique Santé Publique, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France; Inserm, Centre d'Investigation Clinique 1430, Créteil, France; EA EpidermE, Université Paris-Est Créteil, Créteil, France.
| | - Francois Hemery
- Département d'Information Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Jean Winoc Decousser
- Département de Virologie, Bactériologie- Hygiène, Parasitologie-Mycologie, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Romain Bosc
- Service de Chirurgie Plastique, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Roland Amathieu
- Service d'Anesthésie et des Réanimations Chirurgicales, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Alain Rahmouni
- Département d'Imagerie Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Pierre Wolkenstein
- Département de Dermatologie, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France; Inserm, Centre d'Investigation Clinique 1430, Créteil, France; EA EpidermE, Université Paris-Est Créteil, Créteil, France
| | - Laurence Valeyrie-Allanore
- Département de Dermatologie, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France; Inserm, Centre d'Investigation Clinique 1430, Créteil, France; EA EpidermE, Université Paris-Est Créteil, Créteil, France
| | - Christian Brun-Buisson
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, France; UPEC-Université Paris-Est Créteil Val de Marne, Faculté de médecine de Créteil, CARMAS Research Group, Créteil, France
| | - Nicolas de Prost
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, France; UPEC-Université Paris-Est Créteil Val de Marne, Faculté de médecine de Créteil, CARMAS Research Group, Créteil, France
| | - Olivier Chosidow
- Département de Dermatologie, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France; Inserm, Centre d'Investigation Clinique 1430, Créteil, France; EA EpidermE, Université Paris-Est Créteil, Créteil, France
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18
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McCormack M, Valiquette AS, Ismail S. Fournier's gangrene: A retrospective analysis of 26 cases in a Canadian hospital and literature review. Can Urol Assoc J 2015. [PMID: 26225189 DOI: 10.5489/cuaj.2445] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We performed a systematic review of all cases of Fournier's Gangrene (FG) at our hospital over a 12-year period. A total of 26 cases were assessed. Our goal was to determine the mortality rate and to identify risk factors associated with FG. We also wanted to examine three potential prognostic factors in relation to patient survival, including the time delay from emergency room admission to surgery, the initial extent of the disease, and the impact of more than one debridement procedure under general anesthesia. The time between emergency room admission and the beginning of surgical debridement was not statistically different between survivors and non-survivors. The extent of surgical debridement was close to the margin of statistical significance (p = 0.07) and can be considered an index of the extent of the disease. FG extending to the thighs or to the abdominal wall carries a worse prognosis. The number of surgical debridement procedures done under anesthesia was statistically different between survivors and non-survivors. Patients were 4.8 times more at risk of dying if they are required to have more than one surgical debridement under general anesthesia. This presumably reflects persistent gangrene following initial surgical debridement, fluid resuscitation, and wide spectrum antibiotic treatment.
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Affiliation(s)
| | | | - Salima Ismail
- Department of Surgery, University of Montreal, Montreal, QC
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19
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Khamnuan P, Chongruksut W, Jearwattanakanok K, Patumanond J, Tantraworasin A. Clinical predictors for severe sepsis in patients with necrotizing fasciitis: an observational cohort study in northern Thailand. Infect Drug Resist 2015. [PMID: 26213473 PMCID: PMC4509542 DOI: 10.2147/idr.s85249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Necrotizing fasciitis (NF) is a life-threatening infection of skin and fascia. Its progress is extremely fast, with extensive necrosis. Delay in treatment, with subsequent huge soft tissue loss and associated severe sepsis, remains a major cause of death in the management of NF. Objective The aim of this study was to explore clinical characteristics that may be used to predict severe sepsis in patients with NF, in the context of routine clinical practice in northern Thailand. Methods A retrospective observational cohort study was conducted. The patient cohort in this study consisted of all patients who were diagnosed with NF by surgical or pathological confirmation. The follow-up period started with the admission date and ended with the discharge date. The clinical variables were collected from patients registered at three provincial hospitals in northern Thailand from 2009 to 2012. The clinical predictors for severe sepsis were analyzed using multivariable risk regression. Results A total of 1,452 patients were diagnosed with NF, either with severe sepsis (n=237 [16.3%]) or without severe sepsis (n=1,215 [83.7%]). From the multivariable analysis, female sex (relative risk [RR] =1.51; 95% confidence interval [CI] =1.04–2.20), diabetes mellitus (RR =1.40; 95% CI =1.25–1.58), chronic heart disease (RR =1.31; 95% CI =1.15–1.49), hemorrhagic bleb (RR =1.47; 95% CI =1.32–1.63), skin necrosis (RR =1.45; 95% CI =1.34–1.57), and serum protein <6 g/dL (RR =2.67; 95% CI =1.60–4.47) were all predictive factors for severe sepsis. Conclusion The clinical predictors for severe sepsis in patients with suspicion of NF included female sex, diabetes mellitus, chronic heart disease, hemorrhagic bleb, skin necrosis, and serum protein <6 d/dL. The risk ratio was much higher in patients with total protein less than 6 g/dL, which is associated with malnutrition. Therefore, provision of sufficient nutritional support and close monitoring for these clinical predictors may be beneficial to reduce morbidity and mortality.
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Affiliation(s)
- Patcharin Khamnuan
- Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand ; Department of Nursing, Phayao Hospital, Phayao, Thailand
| | - Wilaiwan Chongruksut
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Jayanton Patumanond
- Clinical Epidemiology Unit, Clinical Research Center, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Apichat Tantraworasin
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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20
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Kaufmann JA, Ramponi D. Recognition of Risk Factors and Prognostic Indicators in Fournier's Gangrene. Crit Care Nurs Q 2015; 38:143-53. [DOI: 10.1097/cnq.0000000000000055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Pseudoaneurysm leading to necrotizing fasciitis at the femoral arterial puncture site. Arch Plast Surg 2014; 41:81-4. [PMID: 24511500 PMCID: PMC3915162 DOI: 10.5999/aps.2014.41.1.81] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 06/14/2013] [Accepted: 06/27/2013] [Indexed: 11/23/2022] Open
Abstract
In this article, we present two cases of femoral pseudoaneurysm (PA) at the femoral arterial puncture site followed by necrotizing fasciitis, which is rare but can be fatal when not managed appropriately. PA was revealed by lower-extremity angiography and color-flow Doppler ultrasonography. Hematoma removal, thrombolysis, and bleeder ligation with Gelfoam were repeatedly performed by a vascular surgeon. When necrotizing fasciitis developed, aggressive surgical drainage and creation of a viable wound bed for reconstruction were mandatory. We adopted a vacuum-assisted closure device (Kinetics Concepts International) as the standard treatment for complicated, serious, infected PA of the puncture site. Excellent clinical outcomes were obtained.
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22
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Markeson D, Nijjar R, Evgeniou E, Kulkarni M. An elderly patient presenting with hip pain following a fall: an unusual presentation of necrotising fasciitis. BMJ Case Rep 2012; 2012:bcr-2012-006659. [PMID: 23045441 DOI: 10.1136/bcr-2012-006659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Necrotising fasciitis (NF) is a rapidly progressive soft tissue infection involving necrosis of subcutaneous tissues. Early surgical intervention reduces mortality, but initial clinical findings are often non-specific and can delay the diagnosis. An 80-year-old patient, presented to our emergency department with pain in her left hip and mild bruising following a fall. An x-ray, requested to investigate a possible hip fracture, in fact demonstrated air in the subcutaneous tissues. She rapidly deteriorated and soon developed blood-filled blisters, crepitus and fixed staining of the skin. She underwent urgent debridement of involved tissues in theatre confirming the diagnosis of NF. The presence of subcutaneous emphysema on plain radiograph as in this case, is extremely specific to the diagnosis of NF. Although other imaging modalities can aid diagnosis these remain as an adjunct rather than a definitive diagnostic tool and should not delay surgical intervention based on clinical findings.
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Affiliation(s)
- Daniel Markeson
- Department of Plastic Surgery, Wexham Park Hospital, Slough, Berkshire, UK
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