Necrotizing fasciitis(NF)is a rapidly progressing,life-threatening soft tissue infection,with upper limb NF posing a particularly serious threat to patient survival and quality of life.Negative pressure wound therapy(...Necrotizing fasciitis(NF)is a rapidly progressing,life-threatening soft tissue infection,with upper limb NF posing a particularly serious threat to patient survival and quality of life.Negative pressure wound therapy(NPWT)has shown considerable advantages in accelerating wound healing and mitigating functional impairment.A retrospective study by Lipatov et al.demonstrated that NPWT significantly reduced the time needed for wound closure preparation while enhancing the success rate of local repair.Despite its benefits,certain limitations highlight the need for further optimization.This paper investigates the potential for personalized dynamic regulation of NPWT,its integration with adjunctive therapies,and the role of multidisciplinary collaboration.Furthermore,it explores the incorporation of advanced technologies such as artificial intelligence,imaging modalities,and biomaterials,presenting novel pathways for the personalized management and global standardization of NF treatment.展开更多
BACKGROUND Necrotizing fasciitis(NF)is a potentially fatal bacterial infection of the soft tissues.Liver cirrhosis appears to be a contributing factor to higher morbidity and mor-tality in patients with NF.This resear...BACKGROUND Necrotizing fasciitis(NF)is a potentially fatal bacterial infection of the soft tissues.Liver cirrhosis appears to be a contributing factor to higher morbidity and mor-tality in patients with NF.This research article explores the relationship between these two conditions.AIM To evaluate whether liver cirrhosis increases morbidity and mortality in patients with NF,focusing on inpatient mortality,septic shock,length of stay,and hospital costs.METHODS This retrospective cohort study utilized data from the Healthcare Cost and Utilization Project 2019 National Inpatient Sample.Cases were identified as pa-tients with both NF and cirrhosis,while controls were non-cirrhotic.The study focused on inpatient mortality as the primary outcome,with secondary outcomes including surgical limb amputation,mechanical ventilation rates,septic shock,length of stay,and hospital costs.RESULTS A total of 14920 patients were admitted to the hospital for management of NF,of which 2.11%had liver cirrhosis.Inpatient mortality was higher in cirrhotic patients(9.5%vs 3%;adjusted odds ratio=3.78;P value=0.02).Cirrhotic patients also had higher rates of septic shock(10.5%vs 4.9%,P value<0.01).Length of hospital stay,total charges,and rates of mechanical ventilation were not statistically different between groups.CONCLUSION Liver cirrhosis is an independent risk factor of in-hospital mortality and morbidity in patients with NF.Clinicians should be aware of this association to ensure better clinical outcomes and spare healthcare expenditure.展开更多
Objective:To summarize the nursing experience of a patient with necrotizing fasciitis(NF)secondary to hypoproteinemia after spinal tumor resection.Methods:We analyzed the clinical data of a patient with hypoproteinemi...Objective:To summarize the nursing experience of a patient with necrotizing fasciitis(NF)secondary to hypoproteinemia after spinal tumor resection.Methods:We analyzed the clinical data of a patient with hypoproteinemia and described in detail his symptoms,examination results,and diagnosis.We explored the evaluation method of hypoproteinemia in orthopedic patients and its relationship with adverse postoperative outcomes,including the risk of reoperation and rehospitalization,the impact on postoperative wound healing,and the increased probability of wound infection.We also introduced the symptoms of NF and traditional Chinese medicine treatment methods,including debridement and drainage of NF and corresponding nursing measures.These measures involve wound management,antiinfection treatment,psychological nursing,pain management,complication monitoring and treatment,dietary guidance,etc.TCM nursing includes treatment methods such as hip bath and moxibustion.Results:After careful treatment and nursing,the patient was discharged 36 d after admission.Conclusions:The nursing experience from this case shows that early diagnosis and comprehensive treatment are essential for NF secondary to hypoproteinemia after resection of a spinal tumor.While evaluating and managing hypoproteinemia,it is essential that the postoperative condition of patients must be closely monitored,any occurrence of complications must be dealt with in time,and effective nursing measures,including TCM treatment methods,must be taken to promote the recovery and good prognosis of patients.展开更多
Objective:To explore the key points of early identification and comprehensive nursing intervention strategy for necrotizing fasciitis patients,to improve the efficiency of clinical diagnosis and treatment and the qual...Objective:To explore the key points of early identification and comprehensive nursing intervention strategy for necrotizing fasciitis patients,to improve the efficiency of clinical diagnosis and treatment and the quality of prognosis.Methods:The clinical data of a 70-year-old female patient with right-hand trauma complicated by infection progressing to necrotizing fasciitis were reviewed and analyzed.Laboratory,imaging,and surgical findings were integrated to summarize the early identification features and key nursing considerations.Results:The patient retained the affected limb,albeit with some functional limitations,following early identification,timely surgical debridement,broad-spectrum anti-infective therapy,and comprehensive nursing care.Conclusion:The early clinical manifestations of necrotizing fasciitis are often subtle,and the disease progresses rapidly.This necessitates heightened vigilance among medical staff in all healthcare settings.Implementing multidisciplinary collaboration and systematic nursing interventions can improve patient prognosis while reducing amputation rates and mortality.展开更多
Necrotizing fasciitis is a devastating soft tissue infection affecting fascias and subcutaneous soft tissues. Literature reviews have identified several related risk factors, including malignancy, alcoholism, malnutri...Necrotizing fasciitis is a devastating soft tissue infection affecting fascias and subcutaneous soft tissues. Literature reviews have identified several related risk factors, including malignancy, alcoholism, malnutrition, diabetes, male gender and old age. There are only scanty case reports in the literature describing its rare association with colorectal malignancy. All published cases are attributed to bowel perforation resulting in necrotizing fasciitis over the perineal region. Isolated upper or lower limb diseases are rarely identified. Simultaneous upper and lower limb infection in colorectal cancer patients has never been described in the literature. We report an unusual case of multi-limb necrotizing fasciitis in a patient with underlying non-perforated rectal carcinoma.展开更多
Necrotizing fasciitis(NF)is an uncommon,rapidly progressive,and potentially fatal infection of the superficial fascia and subcutaneous tissue.NF caused by an enterocutaneous fistula has special clinical characters com...Necrotizing fasciitis(NF)is an uncommon,rapidly progressive,and potentially fatal infection of the superficial fascia and subcutaneous tissue.NF caused by an enterocutaneous fistula has special clinical characters compared with other types of NF.NF caused by enterocutaneous fistula may have more rapid progress and more severe consequences because of multiple germs infection and corrosion by digestive juices.We treated three cases of NF caused by postoperative enterocutaneous fistula since Jan 2007.We followed empirically the principle of eliminating anaerobic conditions of infection,bypassing or draining digestive juice from the fistula and changing dressings with moist exposed burn therapy impregnated with zinc/silver acetate.These three cases were eventually cured by debridement,antibiotics and wound management.展开更多
BACKGROUND Diffuse fasciitis with psoriatic arthritis on magnetic resonance imaging(MRI) has not been previously described in childhood. Here we present the first case report of a pediatric patient developing fasciiti...BACKGROUND Diffuse fasciitis with psoriatic arthritis on magnetic resonance imaging(MRI) has not been previously described in childhood. Here we present the first case report of a pediatric patient developing fasciitis, beyond plantar fasciitis, with psoriatic arthritis.CASE SUMMARY An 11-year-old female was admitted with the complaints of psoriatic rash on the body associated with severe pain in the lower extremities and arthritis in the right knee. Psoriasis was confirmed by skin biopsy, she diagnosed with juvenile psoriatic arthritis. Diagnostic tests did not indicate any pathology except MRI.MRI of the femur and tibia revealed that high-signal inflammatory changes in the subdermal fascia. These findings led to a diagnosis of psoriatic fasciitis.Methotrexate was given for 3 mo but the patient showed no response to therapy;therefore, etanercept was added. However, there was no response to treatment.Etanercept was switched to adalimumab at the sixth month of therapy. Clinical improvement started with therapy of adalimumab within one month. Fasciitis finding in MRI disappeared at seventh months on adalimumab therapy. She has no complaint for two years with adalimumab.CONCLUSION The most effective imaging method is MRI and adalimumab may be the best choice of treatment for psoriatic fasciitis.展开更多
BACKGROUND Nodular fasciitis(NF)is a benign disease originating from fascial tissue and most commonly occurs in the extremities,followed by the trunk,head,and neck.NF of the head and neck occurs mainly in the face and...BACKGROUND Nodular fasciitis(NF)is a benign disease originating from fascial tissue and most commonly occurs in the extremities,followed by the trunk,head,and neck.NF of the head and neck occurs mainly in the face and neck,and it has not been reported in the occipital region.CASE SUMMARY A 30-year-old man was admitted because of a mass in the left occipital region.Imaging examination revealed a soft tissue nodule in the left occipital area.An enhanced magnetic resonance imaging scan showed characteristic inverted target and fascial tail signs.Histopathological analysis showed a large amount of spindle cell proliferation,and immunohistochemistry showed positive expression of SMA in the spindle cells in the lesion.Finally,nodular fasciitis was diagnosed.CONCLUSION NF of the head and neck is rare,but the possibility of NF should be considered when nodules or masses with rapid subcutaneous growth are found and tenderness in the head and neck is present.Imaging examination,in combination with clinical manifestations and histopathological examination,can improve the diagnostic accuracy for the disease.After diagnosis,local surgical resection is the first choice of treatment.展开更多
BACKGROUND Necrotizing fasciitis is a fulminant necrotizing soft tissue disease with a high fatality rate.It always starts with impact on the deep fascia rapidly and might result in secondary necrosis of the subcutane...BACKGROUND Necrotizing fasciitis is a fulminant necrotizing soft tissue disease with a high fatality rate.It always starts with impact on the deep fascia rapidly and might result in secondary necrosis of the subcutaneous tissue,fascia,and muscle.Thus,timely and multiple surgical operations are needed for the treatment.Meanwhile,the damage of skin and soft tissue caused by multiple surgical operations may require dermatoplasty and other treatments as a consequence.CASE SUMMARY Here,we report a case of 50-year-old male patient who was admitted to our hospital with symptoms of necrotizing fasciitis caused by cryptoglandular infection in the perianal and perineal region.The symptoms of necrotizing fasciitis,also known as the cardinal features,include hyperpyrexia,excruciatingly painful lesions,demonstration gas in the tissue,an obnoxious foul odor and uroschesis.The results of postoperative pathology met the diagnosis.Based on the premise of complete debridement,multiple incisions combined with thread-dragging therapy(a traditional Chinese medicine therapy)and intensive supportive therapies including comprising antibiotics,nutrition and fluids were given.The outcome of the treatment was satisfactory.The patient recovered quickly and achieved ideal anal function and morphology.CONCLUSION Timely and effective debridement and multiple incisions combined with thread-dragging therapy are an integrated treatment for necrotizing fasciitis.展开更多
BACKGROUND Necrotizing fasciitis is a severe bacterial skin infection that spreads quickly and is characterized by extensive necrosis of the deep and superficial fascia resulting in the devascularization and necrosis ...BACKGROUND Necrotizing fasciitis is a severe bacterial skin infection that spreads quickly and is characterized by extensive necrosis of the deep and superficial fascia resulting in the devascularization and necrosis of associated tissues.Because of high morbidity and mortality,accurate diagnosis and early treatment with adequate antibiotics and surgical intervention are vital.And timely identification and treatment of complications are necessary to improve survival of patient.CASE SUMMARY We report a case of necrotizing fasciitis caused by Staphylococcus aureus in a patient using high doses of glucocorticoid and suffering from secondary diabetes mellitus.He was admitted to our hospital due to redness and oedema of the lower limbs.After admission,necrotizing fasciitis caused by Staphylococcus aureus was considered,and he was discharged after B-ultrasound drainage and multiple surgical operations.In the process of treatment,multiple organ functions were damaged,but with the help of multi-disciplinary treatment,the patient got better finally.CONCLUSION The key to successful management of necrotizing fasciitis is an early and accurate diagnosis.The method of using vacuum sealing drainage in postoperative patients can keep the wound dry and clean,reduce infection rate,and promote wound healing.Interdisciplinary collaboration is a vital prerequisite for successful treatment.展开更多
BACKGROUND Eosinophilic fasciitis(EF)is a rare connective tissue disease that can cause swelling and sclerosis of the extremities,and special attention is needed to differentiate EF from systemic sclerosis.Misdiagnosi...BACKGROUND Eosinophilic fasciitis(EF)is a rare connective tissue disease that can cause swelling and sclerosis of the extremities,and special attention is needed to differentiate EF from systemic sclerosis.Misdiagnosis or omission markedly delays treatment of EF,and severe skin sclerosis in advanced stages can cause joint contracture and tendon retraction,worsening the patient's prognosis and quality of life.CASE SUMMARY We report a case of EF in a young woman diagnosed by tissue biopsy,confirming the difficulty of differential diagnosis with scleroderma.CONCLUSION Focusing on skin manifestations,completing tissue biopsy and radiography can help diagnose EF effectively.Clinicians should enhance their understanding of the differences between EF and scleroderma,and early diagnosis and standardized treatment can improve the prognosis of patients with EF.展开更多
BACKGROUND Eosinophilic fasciitis(EF)is a rare disease characterized by inflammation of the fascia with immune system involvement.Failure to promptly diagnose and treat this disease can seriously affect the quality of...BACKGROUND Eosinophilic fasciitis(EF)is a rare disease characterized by inflammation of the fascia with immune system involvement.Failure to promptly diagnose and treat this disease can seriously affect the quality of life of patients.However,no clear and uniform criteria for diagnosis and treatment exist.CASE SUMMARY In this paper,we report two cases of EF,both of which showed symmetrical limb swelling and rigidity,increased eosinophils in the peripheral blood and bone marrow,increased red blood cell sedimentation rate,increased antinuclear antibody titer,and pathological changes in the tissues such as eosinophil and lymphocyte infiltration.Both patients were treated with hormones and cyclosporine,and showed significant improvements in their conditions.CONCLUSION EF is an autoimmune disease causing swelling and sclerosis of the fascia and eosinophilia.It is diagnosable by magnetic resonance imaging,positron emission tomography-computed tomography,blood routine tests,and bone marrow puncture.Glucocorticoids and immunosuppressants are effective treatments.展开更多
Background: Necrotizing fasciitis (NF) is a rare but life-threatening soft-tissue infection characterized by rapidly spreading inflammation and subsequent necrosis of the fascial planes and surrounding tissue. Aim: To...Background: Necrotizing fasciitis (NF) is a rare but life-threatening soft-tissue infection characterized by rapidly spreading inflammation and subsequent necrosis of the fascial planes and surrounding tissue. Aim: To determine the clinical characteristics at presentation, causative pathogens and clinical outcome of NF after aggressive management. Patients and methods: We retrospectively reviewed case notes of patients with NF referred to the Teaching Hospital in Port Harcourt from January 2004 to December 2009. Results: The case notes of over 2,280 patients with history of cellulitis and/or infections of the upper and lower limbs were reviewed. These cases were seen in a five-year period from 2004 to 2009. Seventy five (3.29%) patients had a diagnosis of necrotizing fasciitis and were evaluated. Only those with infections on the lower and upper limbs were further analyzed. Thirty five (46.67%) patients had their infections in the lower limb while 40 (53.33%) patients had their infections in the upper limb. Twenty (26.67%) patients were found to be diabetic on admission. Thirty (30%) patients sustained injuries on their limbs while 5 (6.67%) patients could not give account of their infections. Eleven (14.66%) patients had fixed flexion deformities as their wounds healed and had to have further plastic surgery to extend their limbs and 7 (9.33%) patients died while on admission. Conclusion: Although an early diagnosis of NF can be difficult, a high index of suspicion is required in all patients presenting with unexplained warmth and/or cellulitis of the limbs, so that prompt and aggressive debridement can be carried out with commencement of broad spectrum antibiotics.展开更多
<span style="font-family:Verdana;">Background and Purpose: Plantar Fasciitis (PF) is a condition that affects the foot and causes complaints such as pain and stiffness. The most common symptom of this ...<span style="font-family:Verdana;">Background and Purpose: Plantar Fasciitis (PF) is a condition that affects the foot and causes complaints such as pain and stiffness. The most common symptom of this condition is pain. There are many treatment options to deal with this condition, such as conservative therapy, medications</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> and surgical interventions in rare cases. This case study aims to investigate the potential impact of pain neuroscience education (PNE), combined with a conventional Physical Therapy (PT) program on a 37-year-old-patient with chronic plantar fasciitis. Case description: A 37-year-old male health care professional presented to an outpatient physical therapy clinic with a diagnosis of chronic PF for around two years. The participant had tried several treatment options with no improvement of his symptoms. After undergoing a physical therapy evaluation, he was given a plan of care for twelve sessions by a skilled physical therapist for a six-week period, with each session consisting of 30 minutes of conventional PT, followed by 5 to 15 minutes of PNE. Results: After completing the prescribed plan of care, the patient reported </span><span style="font-family:Verdana;">a </span><span style="font-family:Verdana;">reduction in subjective symptoms via the Visual Analog Scale (VAS). He also reported improvement with symptoms and functional independence via the Foot Function Index (FFI). The patient reported no change in </span><span style="font-family:Verdana;">the </span><span style="font-family:Verdana;">quality of sleep via Pittsburg Sleep Quality Index (PSQI). Lastly, he demonstrated no objective improvement in foot pressure with the Navicular Drop Test. Discussion: This case report indicates that PNE, combined with conventional PT for PF can have a positive impact on subjective pain and foot function. PNE should involve many topics about the physiology of pain and the nervous system and should be administered by a certified therapeutic pain specialist. Further studies are recommended to investigate the impact of this intervention in combination with traditional PT for PF in larger populations.</span>展开更多
Rationale: Necrotizing fasciitis is an aggressive infection of subcutaneous tissues, which tends to spread rapidly through the fascial planes. Colonic diverticulosis is a common disease in advanced age, although it ra...Rationale: Necrotizing fasciitis is an aggressive infection of subcutaneous tissues, which tends to spread rapidly through the fascial planes. Colonic diverticulosis is a common disease in advanced age, although it rarely causes a lethal necrotizing soft-tissue infection. Patient concerns: A 58-year-old woman complained of left leg pain for 15 d without abdominal pain. Diagnosis: Diverticulitis perforation presented as necrotizing fasciitis of the left thigh. Interventions: Extensive debridement. Outcomes: The patient died due to sepsis-induced multiple organ failure and severe metabolic acidosis. Lessons: Clinicians should be aware of presentations of diverticulitis in patients who have a soft-tissue infection in lower extremity even though patients may not have had a history of diverticulosis or abdominal pain.展开更多
Rationale: Necrotizing fasciitis is a rare infection of fascia tissues. It progresses quickly and has high morbidity and mortality. In this study, we aimed to explore a case of necrotizing fasciitis in a diabetic pati...Rationale: Necrotizing fasciitis is a rare infection of fascia tissues. It progresses quickly and has high morbidity and mortality. In this study, we aimed to explore a case of necrotizing fasciitis in a diabetic patient. Patient concerns: A 46-year-old woman presented with severe pain and inflammation in the left leg, and with fever and chills. Diagnosis: Necrotizing fasciitis in the left leg. Intervention: Broad debridement of infectious tissues and broad-spectrum venous antibiotics. Outcomes: The patient was discharged without pain, inflation, or fever. Lesson: This disease is a surgical emergency, therefore, early diagnosis and quick and invasive treatment could significantly decrease morbidity and mortality.展开更多
BACKGROUND Intravascular fasciitis(IVF)is a rare nodular fasciitis that often involves the layers and lumens of blood vessels;therefore,it is easily misdiagnosed as a malignant tumor with invasion into blood vessels.C...BACKGROUND Intravascular fasciitis(IVF)is a rare nodular fasciitis that often involves the layers and lumens of blood vessels;therefore,it is easily misdiagnosed as a malignant tumor with invasion into blood vessels.CASE SUMMARY A 13-year-old boy was admitted due to a mass on the left side of his neck.Duplex ultrasonography revealed a circular solid hypoechoic mass in the external jugular vein,and magnetic resonance imaging revealed an enhanced longitudinal masslike lesion in the left supraclavicular fossa.Surgical treatment was arranged and completed,histopathological analysis showed a large amount of spindle cell proliferation,and immunohistochemistry showed that the spindle cells were positive for the expression of vimentin,caldesmon,and smooth muscle actin and negative for the expression of S-100 protein,desmin,CD34,and c-kit;Ki-67 staining revealed a low proliferative index(5%-10%),which confirmed the differentiation characteristics of myofibroblasts.Fluorescence in situ hybridization detected the rearrangement of USP6.IVF was subsequently diagnosed.CONCLUSION IVF is characterized by intraluminal,intramural and extramural involvement of small to large arteries or veins.Unless the doctor has a deep understanding of the disease or suspects that there is an initial indicator,IVF may be confused with other intravascular malignancies,leading to unnecessary radical surgery.Imaging examination combined with histopathological examination can improve the diagnostic accuracy of this disease.展开更多
BACKGROUND Nodular fasciitis(NF)is a self-limiting tumor that mostly occurs in the subcutaneous superficial fascia.NF originating from the appendicular periosteum is extremely rare.A large NF lesion of periosteal orig...BACKGROUND Nodular fasciitis(NF)is a self-limiting tumor that mostly occurs in the subcutaneous superficial fascia.NF originating from the appendicular periosteum is extremely rare.A large NF lesion of periosteal origin can be misdiagnosed as a malignant bone tumor and may cause overtreatment.CASE SUMMARY A right axillary mass was found in a 46-year-old man and was initially diagnosed intraoperatively as low-grade sarcoma,but later diagnosed as NF after postresection histopathological evaluation.Furthermore,fluorescence in situ hybridization analysis revealed a USP6 gene rearrangement that confirmed the diagnosis.To the best of our knowledge,this is the first case of NF in the humeral periosteum.CONCLUSION NF poses a diagnostic challenge as it is often mistaken for sarcoma.Postoperative histopathological examination of whole sections can be combined with immunohistochemical staining and,if necessary,the diagnosis can be confirmed by molecular detection,and thus help avoid overtreatment.展开更多
Nodular fasciitis is a benign reactive soft tissue tumor arising from fibroblasts and myofibroblasts.Its incidence is low and misdiagnosis is frequent especially for malignant lesions.This can lead to inappropriate an...Nodular fasciitis is a benign reactive soft tissue tumor arising from fibroblasts and myofibroblasts.Its incidence is low and misdiagnosis is frequent especially for malignant lesions.This can lead to inappropriate and unnecessary invasive treatment.Nodular fasciitis of the external auditory canal is extremely rare.So far,around fifteen cases have been reported.We present here the case of a 90-year-old patient with nodular fasciitis of the right external auditory canal.The lesion extends anteriorly for 6.5 cm and reaches the posterior wall of the maxillary sinus.To our knowledge,this is the first case in the literature of an external auditory canal nodular fasciitis presenting as an inflammatory ear polyp with such a wide extension.展开更多
BACKGROUND Craniofacial necrotizing fasciitis(CNF)is an uncommon but fatal infection that can spread rapidly through the subfascial planes in the head and neck region.Symptoms usually progress rapidly,and early manage...BACKGROUND Craniofacial necrotizing fasciitis(CNF)is an uncommon but fatal infection that can spread rapidly through the subfascial planes in the head and neck region.Symptoms usually progress rapidly,and early management is necessary to optimize outcomes.CASE SUMMARY A 43-year-old man visited our hospital with left hemifacial swelling involving the buccal and submandibular areas.The patient had fever for approximately 10 d before visiting the hospital,but did not report any other systemic symptoms.Computed tomography scan demonstrated an abscess with gas formation.After surgical drainage of the facial abscess,the patient’s systemic condition worsened and progressed to septic shock.Further examination revealed pulmonary and renal abscesses.Renal percutaneous catheter drainage was performed at the renal abscess site,which caused improvement of symptoms.The patient showed no evidence of systemic complications during the 4-mo post-operative follow-up period.CONCLUSION As the patient did not improve with conventional CNF treatment and symptoms only resolved after controlling the infection,the final diagnosis was secondary CNF with septic emboli.Aggressive surgical decompression is important for CNF management.However,if symptoms worsen despite early diagnosis and management,such as pus drainage and surgical intervention,clinicians should consider the possibility of a secondary abscess from internal organs.展开更多
基金Supported by Henan Province Key Research and Development Program,No.231111311000Henan Provincial Science and Technology Research Project,No.232102310411+2 种基金Henan Province Medical Science and Technology Key Project,No.LHGJ20220566 and No.LHGJ20240365Henan Province Medical Education Research Project,No.WJLX2023079Zhengzhou Medical and Health Technology Innovation Guidance Program,No.2024YLZDJH022.
文摘Necrotizing fasciitis(NF)is a rapidly progressing,life-threatening soft tissue infection,with upper limb NF posing a particularly serious threat to patient survival and quality of life.Negative pressure wound therapy(NPWT)has shown considerable advantages in accelerating wound healing and mitigating functional impairment.A retrospective study by Lipatov et al.demonstrated that NPWT significantly reduced the time needed for wound closure preparation while enhancing the success rate of local repair.Despite its benefits,certain limitations highlight the need for further optimization.This paper investigates the potential for personalized dynamic regulation of NPWT,its integration with adjunctive therapies,and the role of multidisciplinary collaboration.Furthermore,it explores the incorporation of advanced technologies such as artificial intelligence,imaging modalities,and biomaterials,presenting novel pathways for the personalized management and global standardization of NF treatment.
文摘BACKGROUND Necrotizing fasciitis(NF)is a potentially fatal bacterial infection of the soft tissues.Liver cirrhosis appears to be a contributing factor to higher morbidity and mor-tality in patients with NF.This research article explores the relationship between these two conditions.AIM To evaluate whether liver cirrhosis increases morbidity and mortality in patients with NF,focusing on inpatient mortality,septic shock,length of stay,and hospital costs.METHODS This retrospective cohort study utilized data from the Healthcare Cost and Utilization Project 2019 National Inpatient Sample.Cases were identified as pa-tients with both NF and cirrhosis,while controls were non-cirrhotic.The study focused on inpatient mortality as the primary outcome,with secondary outcomes including surgical limb amputation,mechanical ventilation rates,septic shock,length of stay,and hospital costs.RESULTS A total of 14920 patients were admitted to the hospital for management of NF,of which 2.11%had liver cirrhosis.Inpatient mortality was higher in cirrhotic patients(9.5%vs 3%;adjusted odds ratio=3.78;P value=0.02).Cirrhotic patients also had higher rates of septic shock(10.5%vs 4.9%,P value<0.01).Length of hospital stay,total charges,and rates of mechanical ventilation were not statistically different between groups.CONCLUSION Liver cirrhosis is an independent risk factor of in-hospital mortality and morbidity in patients with NF.Clinicians should be aware of this association to ensure better clinical outcomes and spare healthcare expenditure.
文摘Objective:To summarize the nursing experience of a patient with necrotizing fasciitis(NF)secondary to hypoproteinemia after spinal tumor resection.Methods:We analyzed the clinical data of a patient with hypoproteinemia and described in detail his symptoms,examination results,and diagnosis.We explored the evaluation method of hypoproteinemia in orthopedic patients and its relationship with adverse postoperative outcomes,including the risk of reoperation and rehospitalization,the impact on postoperative wound healing,and the increased probability of wound infection.We also introduced the symptoms of NF and traditional Chinese medicine treatment methods,including debridement and drainage of NF and corresponding nursing measures.These measures involve wound management,antiinfection treatment,psychological nursing,pain management,complication monitoring and treatment,dietary guidance,etc.TCM nursing includes treatment methods such as hip bath and moxibustion.Results:After careful treatment and nursing,the patient was discharged 36 d after admission.Conclusions:The nursing experience from this case shows that early diagnosis and comprehensive treatment are essential for NF secondary to hypoproteinemia after resection of a spinal tumor.While evaluating and managing hypoproteinemia,it is essential that the postoperative condition of patients must be closely monitored,any occurrence of complications must be dealt with in time,and effective nursing measures,including TCM treatment methods,must be taken to promote the recovery and good prognosis of patients.
文摘Objective:To explore the key points of early identification and comprehensive nursing intervention strategy for necrotizing fasciitis patients,to improve the efficiency of clinical diagnosis and treatment and the quality of prognosis.Methods:The clinical data of a 70-year-old female patient with right-hand trauma complicated by infection progressing to necrotizing fasciitis were reviewed and analyzed.Laboratory,imaging,and surgical findings were integrated to summarize the early identification features and key nursing considerations.Results:The patient retained the affected limb,albeit with some functional limitations,following early identification,timely surgical debridement,broad-spectrum anti-infective therapy,and comprehensive nursing care.Conclusion:The early clinical manifestations of necrotizing fasciitis are often subtle,and the disease progresses rapidly.This necessitates heightened vigilance among medical staff in all healthcare settings.Implementing multidisciplinary collaboration and systematic nursing interventions can improve patient prognosis while reducing amputation rates and mortality.
文摘Necrotizing fasciitis is a devastating soft tissue infection affecting fascias and subcutaneous soft tissues. Literature reviews have identified several related risk factors, including malignancy, alcoholism, malnutrition, diabetes, male gender and old age. There are only scanty case reports in the literature describing its rare association with colorectal malignancy. All published cases are attributed to bowel perforation resulting in necrotizing fasciitis over the perineal region. Isolated upper or lower limb diseases are rarely identified. Simultaneous upper and lower limb infection in colorectal cancer patients has never been described in the literature. We report an unusual case of multi-limb necrotizing fasciitis in a patient with underlying non-perforated rectal carcinoma.
基金Supported by General Projects of the Chinese PLA"Twelfth Five-Year"Logistics Research Subject,No.CKJ11J020
文摘Necrotizing fasciitis(NF)is an uncommon,rapidly progressive,and potentially fatal infection of the superficial fascia and subcutaneous tissue.NF caused by an enterocutaneous fistula has special clinical characters compared with other types of NF.NF caused by enterocutaneous fistula may have more rapid progress and more severe consequences because of multiple germs infection and corrosion by digestive juices.We treated three cases of NF caused by postoperative enterocutaneous fistula since Jan 2007.We followed empirically the principle of eliminating anaerobic conditions of infection,bypassing or draining digestive juice from the fistula and changing dressings with moist exposed burn therapy impregnated with zinc/silver acetate.These three cases were eventually cured by debridement,antibiotics and wound management.
文摘BACKGROUND Diffuse fasciitis with psoriatic arthritis on magnetic resonance imaging(MRI) has not been previously described in childhood. Here we present the first case report of a pediatric patient developing fasciitis, beyond plantar fasciitis, with psoriatic arthritis.CASE SUMMARY An 11-year-old female was admitted with the complaints of psoriatic rash on the body associated with severe pain in the lower extremities and arthritis in the right knee. Psoriasis was confirmed by skin biopsy, she diagnosed with juvenile psoriatic arthritis. Diagnostic tests did not indicate any pathology except MRI.MRI of the femur and tibia revealed that high-signal inflammatory changes in the subdermal fascia. These findings led to a diagnosis of psoriatic fasciitis.Methotrexate was given for 3 mo but the patient showed no response to therapy;therefore, etanercept was added. However, there was no response to treatment.Etanercept was switched to adalimumab at the sixth month of therapy. Clinical improvement started with therapy of adalimumab within one month. Fasciitis finding in MRI disappeared at seventh months on adalimumab therapy. She has no complaint for two years with adalimumab.CONCLUSION The most effective imaging method is MRI and adalimumab may be the best choice of treatment for psoriatic fasciitis.
文摘BACKGROUND Nodular fasciitis(NF)is a benign disease originating from fascial tissue and most commonly occurs in the extremities,followed by the trunk,head,and neck.NF of the head and neck occurs mainly in the face and neck,and it has not been reported in the occipital region.CASE SUMMARY A 30-year-old man was admitted because of a mass in the left occipital region.Imaging examination revealed a soft tissue nodule in the left occipital area.An enhanced magnetic resonance imaging scan showed characteristic inverted target and fascial tail signs.Histopathological analysis showed a large amount of spindle cell proliferation,and immunohistochemistry showed positive expression of SMA in the spindle cells in the lesion.Finally,nodular fasciitis was diagnosed.CONCLUSION NF of the head and neck is rare,but the possibility of NF should be considered when nodules or masses with rapid subcutaneous growth are found and tenderness in the head and neck is present.Imaging examination,in combination with clinical manifestations and histopathological examination,can improve the diagnostic accuracy for the disease.After diagnosis,local surgical resection is the first choice of treatment.
基金the Young Talent Program of LongHua Hospital Shanghai University of Traditional Chinese Medicine,No.RC-2019-01-01and the Shanghai Three-year Action Plan of Further Accelerated Development in Traditional Chinese Medicine,No.ZY(2018-2020)-CCCX-1007.
文摘BACKGROUND Necrotizing fasciitis is a fulminant necrotizing soft tissue disease with a high fatality rate.It always starts with impact on the deep fascia rapidly and might result in secondary necrosis of the subcutaneous tissue,fascia,and muscle.Thus,timely and multiple surgical operations are needed for the treatment.Meanwhile,the damage of skin and soft tissue caused by multiple surgical operations may require dermatoplasty and other treatments as a consequence.CASE SUMMARY Here,we report a case of 50-year-old male patient who was admitted to our hospital with symptoms of necrotizing fasciitis caused by cryptoglandular infection in the perianal and perineal region.The symptoms of necrotizing fasciitis,also known as the cardinal features,include hyperpyrexia,excruciatingly painful lesions,demonstration gas in the tissue,an obnoxious foul odor and uroschesis.The results of postoperative pathology met the diagnosis.Based on the premise of complete debridement,multiple incisions combined with thread-dragging therapy(a traditional Chinese medicine therapy)and intensive supportive therapies including comprising antibiotics,nutrition and fluids were given.The outcome of the treatment was satisfactory.The patient recovered quickly and achieved ideal anal function and morphology.CONCLUSION Timely and effective debridement and multiple incisions combined with thread-dragging therapy are an integrated treatment for necrotizing fasciitis.
基金Supported by National Key Clinical Specialities in the Twelfth Five-Year Plan(Geriatrics Department)“Demonstration Base of Clinical Nutrition for the Elderly” initiated and sponsored by the China Health Promotion Foundation
文摘BACKGROUND Necrotizing fasciitis is a severe bacterial skin infection that spreads quickly and is characterized by extensive necrosis of the deep and superficial fascia resulting in the devascularization and necrosis of associated tissues.Because of high morbidity and mortality,accurate diagnosis and early treatment with adequate antibiotics and surgical intervention are vital.And timely identification and treatment of complications are necessary to improve survival of patient.CASE SUMMARY We report a case of necrotizing fasciitis caused by Staphylococcus aureus in a patient using high doses of glucocorticoid and suffering from secondary diabetes mellitus.He was admitted to our hospital due to redness and oedema of the lower limbs.After admission,necrotizing fasciitis caused by Staphylococcus aureus was considered,and he was discharged after B-ultrasound drainage and multiple surgical operations.In the process of treatment,multiple organ functions were damaged,but with the help of multi-disciplinary treatment,the patient got better finally.CONCLUSION The key to successful management of necrotizing fasciitis is an early and accurate diagnosis.The method of using vacuum sealing drainage in postoperative patients can keep the wound dry and clean,reduce infection rate,and promote wound healing.Interdisciplinary collaboration is a vital prerequisite for successful treatment.
基金Supported by National Natural Science Foundation of China,No.81704050National High Level Hospital Clinical Research Funding,No.2022-NHLHCRF-LX-02-0103 and No.2022-NHLHCRF-LX-02-0104.
文摘BACKGROUND Eosinophilic fasciitis(EF)is a rare connective tissue disease that can cause swelling and sclerosis of the extremities,and special attention is needed to differentiate EF from systemic sclerosis.Misdiagnosis or omission markedly delays treatment of EF,and severe skin sclerosis in advanced stages can cause joint contracture and tendon retraction,worsening the patient's prognosis and quality of life.CASE SUMMARY We report a case of EF in a young woman diagnosed by tissue biopsy,confirming the difficulty of differential diagnosis with scleroderma.CONCLUSION Focusing on skin manifestations,completing tissue biopsy and radiography can help diagnose EF effectively.Clinicians should enhance their understanding of the differences between EF and scleroderma,and early diagnosis and standardized treatment can improve the prognosis of patients with EF.
文摘BACKGROUND Eosinophilic fasciitis(EF)is a rare disease characterized by inflammation of the fascia with immune system involvement.Failure to promptly diagnose and treat this disease can seriously affect the quality of life of patients.However,no clear and uniform criteria for diagnosis and treatment exist.CASE SUMMARY In this paper,we report two cases of EF,both of which showed symmetrical limb swelling and rigidity,increased eosinophils in the peripheral blood and bone marrow,increased red blood cell sedimentation rate,increased antinuclear antibody titer,and pathological changes in the tissues such as eosinophil and lymphocyte infiltration.Both patients were treated with hormones and cyclosporine,and showed significant improvements in their conditions.CONCLUSION EF is an autoimmune disease causing swelling and sclerosis of the fascia and eosinophilia.It is diagnosable by magnetic resonance imaging,positron emission tomography-computed tomography,blood routine tests,and bone marrow puncture.Glucocorticoids and immunosuppressants are effective treatments.
文摘Background: Necrotizing fasciitis (NF) is a rare but life-threatening soft-tissue infection characterized by rapidly spreading inflammation and subsequent necrosis of the fascial planes and surrounding tissue. Aim: To determine the clinical characteristics at presentation, causative pathogens and clinical outcome of NF after aggressive management. Patients and methods: We retrospectively reviewed case notes of patients with NF referred to the Teaching Hospital in Port Harcourt from January 2004 to December 2009. Results: The case notes of over 2,280 patients with history of cellulitis and/or infections of the upper and lower limbs were reviewed. These cases were seen in a five-year period from 2004 to 2009. Seventy five (3.29%) patients had a diagnosis of necrotizing fasciitis and were evaluated. Only those with infections on the lower and upper limbs were further analyzed. Thirty five (46.67%) patients had their infections in the lower limb while 40 (53.33%) patients had their infections in the upper limb. Twenty (26.67%) patients were found to be diabetic on admission. Thirty (30%) patients sustained injuries on their limbs while 5 (6.67%) patients could not give account of their infections. Eleven (14.66%) patients had fixed flexion deformities as their wounds healed and had to have further plastic surgery to extend their limbs and 7 (9.33%) patients died while on admission. Conclusion: Although an early diagnosis of NF can be difficult, a high index of suspicion is required in all patients presenting with unexplained warmth and/or cellulitis of the limbs, so that prompt and aggressive debridement can be carried out with commencement of broad spectrum antibiotics.
文摘<span style="font-family:Verdana;">Background and Purpose: Plantar Fasciitis (PF) is a condition that affects the foot and causes complaints such as pain and stiffness. The most common symptom of this condition is pain. There are many treatment options to deal with this condition, such as conservative therapy, medications</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> and surgical interventions in rare cases. This case study aims to investigate the potential impact of pain neuroscience education (PNE), combined with a conventional Physical Therapy (PT) program on a 37-year-old-patient with chronic plantar fasciitis. Case description: A 37-year-old male health care professional presented to an outpatient physical therapy clinic with a diagnosis of chronic PF for around two years. The participant had tried several treatment options with no improvement of his symptoms. After undergoing a physical therapy evaluation, he was given a plan of care for twelve sessions by a skilled physical therapist for a six-week period, with each session consisting of 30 minutes of conventional PT, followed by 5 to 15 minutes of PNE. Results: After completing the prescribed plan of care, the patient reported </span><span style="font-family:Verdana;">a </span><span style="font-family:Verdana;">reduction in subjective symptoms via the Visual Analog Scale (VAS). He also reported improvement with symptoms and functional independence via the Foot Function Index (FFI). The patient reported no change in </span><span style="font-family:Verdana;">the </span><span style="font-family:Verdana;">quality of sleep via Pittsburg Sleep Quality Index (PSQI). Lastly, he demonstrated no objective improvement in foot pressure with the Navicular Drop Test. Discussion: This case report indicates that PNE, combined with conventional PT for PF can have a positive impact on subjective pain and foot function. PNE should involve many topics about the physiology of pain and the nervous system and should be administered by a certified therapeutic pain specialist. Further studies are recommended to investigate the impact of this intervention in combination with traditional PT for PF in larger populations.</span>
文摘Rationale: Necrotizing fasciitis is an aggressive infection of subcutaneous tissues, which tends to spread rapidly through the fascial planes. Colonic diverticulosis is a common disease in advanced age, although it rarely causes a lethal necrotizing soft-tissue infection. Patient concerns: A 58-year-old woman complained of left leg pain for 15 d without abdominal pain. Diagnosis: Diverticulitis perforation presented as necrotizing fasciitis of the left thigh. Interventions: Extensive debridement. Outcomes: The patient died due to sepsis-induced multiple organ failure and severe metabolic acidosis. Lessons: Clinicians should be aware of presentations of diverticulitis in patients who have a soft-tissue infection in lower extremity even though patients may not have had a history of diverticulosis or abdominal pain.
文摘Rationale: Necrotizing fasciitis is a rare infection of fascia tissues. It progresses quickly and has high morbidity and mortality. In this study, we aimed to explore a case of necrotizing fasciitis in a diabetic patient. Patient concerns: A 46-year-old woman presented with severe pain and inflammation in the left leg, and with fever and chills. Diagnosis: Necrotizing fasciitis in the left leg. Intervention: Broad debridement of infectious tissues and broad-spectrum venous antibiotics. Outcomes: The patient was discharged without pain, inflation, or fever. Lesson: This disease is a surgical emergency, therefore, early diagnosis and quick and invasive treatment could significantly decrease morbidity and mortality.
文摘BACKGROUND Intravascular fasciitis(IVF)is a rare nodular fasciitis that often involves the layers and lumens of blood vessels;therefore,it is easily misdiagnosed as a malignant tumor with invasion into blood vessels.CASE SUMMARY A 13-year-old boy was admitted due to a mass on the left side of his neck.Duplex ultrasonography revealed a circular solid hypoechoic mass in the external jugular vein,and magnetic resonance imaging revealed an enhanced longitudinal masslike lesion in the left supraclavicular fossa.Surgical treatment was arranged and completed,histopathological analysis showed a large amount of spindle cell proliferation,and immunohistochemistry showed that the spindle cells were positive for the expression of vimentin,caldesmon,and smooth muscle actin and negative for the expression of S-100 protein,desmin,CD34,and c-kit;Ki-67 staining revealed a low proliferative index(5%-10%),which confirmed the differentiation characteristics of myofibroblasts.Fluorescence in situ hybridization detected the rearrangement of USP6.IVF was subsequently diagnosed.CONCLUSION IVF is characterized by intraluminal,intramural and extramural involvement of small to large arteries or veins.Unless the doctor has a deep understanding of the disease or suspects that there is an initial indicator,IVF may be confused with other intravascular malignancies,leading to unnecessary radical surgery.Imaging examination combined with histopathological examination can improve the diagnostic accuracy of this disease.
基金Supported by Jilin Province Department of Finance Project,No.2019SCZT005,No.2019SRCJ007 and No.2020SCZT007National Natural Science Foundation of China,No.81902342and Health Commission of Jilin Province,No.2019Q002.
文摘BACKGROUND Nodular fasciitis(NF)is a self-limiting tumor that mostly occurs in the subcutaneous superficial fascia.NF originating from the appendicular periosteum is extremely rare.A large NF lesion of periosteal origin can be misdiagnosed as a malignant bone tumor and may cause overtreatment.CASE SUMMARY A right axillary mass was found in a 46-year-old man and was initially diagnosed intraoperatively as low-grade sarcoma,but later diagnosed as NF after postresection histopathological evaluation.Furthermore,fluorescence in situ hybridization analysis revealed a USP6 gene rearrangement that confirmed the diagnosis.To the best of our knowledge,this is the first case of NF in the humeral periosteum.CONCLUSION NF poses a diagnostic challenge as it is often mistaken for sarcoma.Postoperative histopathological examination of whole sections can be combined with immunohistochemical staining and,if necessary,the diagnosis can be confirmed by molecular detection,and thus help avoid overtreatment.
文摘Nodular fasciitis is a benign reactive soft tissue tumor arising from fibroblasts and myofibroblasts.Its incidence is low and misdiagnosis is frequent especially for malignant lesions.This can lead to inappropriate and unnecessary invasive treatment.Nodular fasciitis of the external auditory canal is extremely rare.So far,around fifteen cases have been reported.We present here the case of a 90-year-old patient with nodular fasciitis of the right external auditory canal.The lesion extends anteriorly for 6.5 cm and reaches the posterior wall of the maxillary sinus.To our knowledge,this is the first case in the literature of an external auditory canal nodular fasciitis presenting as an inflammatory ear polyp with such a wide extension.
基金Supported by the National Research Foundation of Korea Grant funded by the Korea Government(MSIT),No.2021R1G1A1008337the Soonchunhyang University Research Fund.
文摘BACKGROUND Craniofacial necrotizing fasciitis(CNF)is an uncommon but fatal infection that can spread rapidly through the subfascial planes in the head and neck region.Symptoms usually progress rapidly,and early management is necessary to optimize outcomes.CASE SUMMARY A 43-year-old man visited our hospital with left hemifacial swelling involving the buccal and submandibular areas.The patient had fever for approximately 10 d before visiting the hospital,but did not report any other systemic symptoms.Computed tomography scan demonstrated an abscess with gas formation.After surgical drainage of the facial abscess,the patient’s systemic condition worsened and progressed to septic shock.Further examination revealed pulmonary and renal abscesses.Renal percutaneous catheter drainage was performed at the renal abscess site,which caused improvement of symptoms.The patient showed no evidence of systemic complications during the 4-mo post-operative follow-up period.CONCLUSION As the patient did not improve with conventional CNF treatment and symptoms only resolved after controlling the infection,the final diagnosis was secondary CNF with septic emboli.Aggressive surgical decompression is important for CNF management.However,if symptoms worsen despite early diagnosis and management,such as pus drainage and surgical intervention,clinicians should consider the possibility of a secondary abscess from internal organs.
