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
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 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 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
BACKGROUND Necrotizing fasciitis(NF)of the upper extremities is a severe surgical pathology,and the incidence of this disease has been steadily increasing in recent decades.Surgical treatment is accompanied by the for...BACKGROUND Necrotizing fasciitis(NF)of the upper extremities is a severe surgical pathology,and the incidence of this disease has been steadily increasing in recent decades.Surgical treatment is accompanied by the formation of extensive wounds,which can be treated with significant difficulties.In recent years,negative pressure wound therapy(NPWT)has proven to be highly effective.It is also promising for the treatment of NF.AIM To explore the effectiveness of NPWT in the treatment of NF of the upper extremities.METHODS The results of the treatment of 36 patients with NF of the upper extremities in two groups(NPWT group and control group;2022−2023)were retrospectively analyzed.In the NPWT group,the NPWT method(120 mmHg;constant mode)was used after surgical treatment.The number of vacuum-assisted dressings in patients ranged from 1 to 3,depending on the dynamics of the wound process.The duration of fixation of one bandage was up to 2−3 d.In the control group,conventional methods of local wound treatment were used.The following indicators were analyzed:The treatment delay,the prevalence of inflammation,the microbial landscape,the number of debridements,the duration of wound preparation for surgical closure,and the nature of skin plastic surgery.RESULTS Most patients experienced a significant treatment delay[4 d,interquartile range(IQR):2–7 d],which led to the spread of the pathological process to the forearm and shoulder.The most common pathogens were Staphylococcus aureus(14;38.9%)and Streptococcus pyogenes(22;61.1%).The average number of debridements per patient was 5(IQR:3–7),with no difference between groups.The average time to prepare wounds for surgical closure was 11±4 d in the NPWT group and 29±10 d(P=0.00001)in the control group.In the NPWT group,the wounds were more often closed with local tissues(15;83.3%),and in the control group,split-thickness skin grafts were more often used(4;50%).CONCLUSION The predominant isolation of Staphylococcus aureus and/or Streptococcus pyogenes from the lesions allowed us to classify these patients as NF type II.Multiple debridement procedures have become a feature of this disease treatment.The use of NPWT has significantly reduced the time required to prepare wounds for surgical closure.Early closure of wounds allows for more frequent use of local tissue repair,which ensures better results.NPWT is a highly effective way to prepare wounds for early surgical closure in patients with upper extremity NF.展开更多
<b><span>Background:</span></b><span> Necrotizing fasciitis is a rapidly spreading soft tissue infection involving the deep facial layers. It can cause secondary necrosis leading to signi...<b><span>Background:</span></b><span> Necrotizing fasciitis is a rapidly spreading soft tissue infection involving the deep facial layers. It can cause secondary necrosis leading to significant morbidity and mortality. The most important predictor of mortality is a delay in diagnosis. In low income countries, that delay must be high and other predictors of morbidity and mortality must be pointed out. </span><b><span>Objective: </span></b><span>To determine necrotizing fasciitis (NF) prognostic factors in a low income country. </span><b><span>Patients and Methods:</span></b><span> It is a prospective and descriptive study conducted over a one-year period from November 1, 2017 to November 1, 2018 about 23 cases of necrotizing fasciitis in two hospitals of Bujumbura. </span><b><span>Results:</span></b><span> The incidence of necrotizing fasciitis in these 2 hospitals (Kamenge Teaching Hospital and Prince Regent Charles Hospital) was 1%. The average age of patients was 41.76 years. Males were predominant with a sex ratio of 1.55. The risk factors for NF were: NSAIDs in 39%;HIV infection in 13%, diabetes mellitus in 4% and high blood pressure in 4%. The average time from symptoms onset to admission was 17.13 days. The mean time from admission to surgical treatment was 4 days with extremes of 1 to 22 days. The most affected site was the lower limb in 82% of cases. All patients (96%) were treated with necrotic tissue debridement. It was associated with skin grafting in 48% of cases. One patient (4%) with diabetes mellitus and HIV infection was amputated. The mortality rate was 22%</span><span> </span><span>(n = 5). Among those 5 patients, there was a combination of risk factors (diabetes mellitus, NSAID use and HIV infection) in 80% (n = 4), 60% (n = 3) were over 60 years of age and 60% (n = 3) were operated 10 days after the onset of symptoms. The average time of hospital stay was 101 days with extremes of 14 to 400 days. </span><b><span>Conclusion:</span></b><span> Necrotizing fasciitis is associated with a high mortality rate in low income countries. The use of NSAIDs;delayed treatment, elderly and immunosuppressive conditions such as diabetes mellitus and HIV are the most prognostic factors in Bujumbura hospitals.</span>展开更多
Emphysematous cholecystitis is a rare subtype of acute cholecystitis characterized by the presence of gas in the gallbladder wall secondary to ischemia. Typically, this is a result of cystic artery vascular compromise...Emphysematous cholecystitis is a rare subtype of acute cholecystitis characterized by the presence of gas in the gallbladder wall secondary to ischemia. Typically, this is a result of cystic artery vascular compromise with a concomitant infection from gas-forming organisms such as Clostridium species, Klebsiella species, or Escherichia coli. The mortality rate of acute emphysematous cholecystitis is 15% - 20% compared with 1.4% in uncomplicated acute cholecystitis. The subsequent development of a cholecystocutaneous fistula, an abnormal connection between the gallbladder and the skin, is also a rare complication of gallbladder disease. We describe a case of a 77-year-old male who presented with right flank necrotizing fasciitis which developed from a cholecystocutaneous fistula secondary to emphysematous cholecystitis. Once the necrotic tissues were adequately debrided, the large open wound was treated with negative pressure wound therapy with instillation (NPWT-i) utilizing hypochlorous acid (HOCL). The wound was closed with a split-thickness skin graft.展开更多
Objective: to deeply analyze the nursing effect of perianal abscess combined with perineal necrotizing fasciitis. Methods: from April 2018 to August 2019, 22 patients with perianal abscess combined with perineal necro...Objective: to deeply analyze the nursing effect of perianal abscess combined with perineal necrotizing fasciitis. Methods: from April 2018 to August 2019, 22 patients with perianal abscess combined with perineal necrotizing fasciitis admitted to our hospital were selected as the subjects of this study. After treatment and nursing, the nursing effect was evaluated. Results: all patients were cured after treatment and nursing, with a 100% success rate of treatment, and there was no complication or functional failure. Conclusion: patients with perianal abscess combined with perineal necrotizing fasciitis not only have a relatively urgent condition, but also develop rapidly, accompanied by more complications, which is easy to lead to death of patients. Effective nursing measures should be taken in clinical practice to reduce the rate of disability and mortality of patients after operation, which can be widely used in clinical treatment.展开更多
This article discusses a case of perianal necrotizing fasciitis from perianal abscess with integrated Chinese and western medicine treatment.It has been concluded that the treatment of perianal necrotizing fasciitis f...This article discusses a case of perianal necrotizing fasciitis from perianal abscess with integrated Chinese and western medicine treatment.It has been concluded that the treatment of perianal necrotizing fasciitis from perianal abscess should focus on dispelling evil,tonifying deficiency,or attack and supplement at the same time in order to achieve the purpose of dispelling evil without harming the right while supporting the right without leaving evil.展开更多
Necrotizing fasciitis (FN) are severe, fulminant infection with necrosis of the skin and superficial fascia. The variability of the clinical picture and the severity of the condition make it a formidable condition. B....Necrotizing fasciitis (FN) are severe, fulminant infection with necrosis of the skin and superficial fascia. The variability of the clinical picture and the severity of the condition make it a formidable condition. B.A, 16 years old, breeder, was admitted to ENT hospitalization for a large necrotic cervico-thoracic and dorsal ulceration of sudden onset following febrile odynophagia. ENT examination: large necrotic wound extending from the antero-posterior cervical region to the thoraco-abdominal and dorsal region, letting pus weld with trismus at 1.5 cm and a fistula of the anterior pillar of the right tonsil. Cytobacteriological examination of the pus isolated Staphylococcus aureus. We instituted a probabilistic antibiotic therapy readjusted afterward to the association amoxicillin clavulanic acid with the result of the antibiogram. Incision, drainage and surgical debridement of all necrotic tissues were performed, leading to extensive loss of skin substance. A daily local dressing was applied for 11 days, then replaced by honey for 51 days. On the 64th day, he was entrusted to the dermatology department for a skin graft where he stayed for 3 months. Conclusion: current name, necrotizing bacterial dermohypodermatitis. Surgery has a key role in treatment. Antibiotic therapy should be broad-spectrum.展开更多
Necrotizing fasciitis(NF)caused by vibrio vulnificus(VV)is a rare but fatal clinical emergency characterized by hemorrhagic bullous skin lesions,septic shock and multiple organ dysfunction syndrome(MODS),commonly occu...Necrotizing fasciitis(NF)caused by vibrio vulnificus(VV)is a rare but fatal clinical emergency characterized by hemorrhagic bullous skin lesions,septic shock and multiple organ dysfunction syndrome(MODS),commonly occurring in patients with chronic liver disease.1,2 In general,mortality of these patients is higher than 60%,which could approach 100%when complicated with septic shock.Therefore,early diagnosis and effectively surgical intervention in emergency room are the mainstays for better outcomes of these patients.However,many emergency physicians lack experiences in diagnosing and managing vibrio NF.Furthermore,due to the preexisting severe medical complications including hypotension,lactic acidosis,coagulation disorders and thrombocytopenia,the optimal therapeutic strategies for these critical patients should obviously be evaluated on a patient-to-patient basis,which remains largely undefined.展开更多
Varicella is a self-limited disease, but sometimes it may be associated with some serious life-threatening complications. Necrotizing fasciitis is a rare complication of varicella. This is a case of a 7-year-old girl ...Varicella is a self-limited disease, but sometimes it may be associated with some serious life-threatening complications. Necrotizing fasciitis is a rare complication of varicella. This is a case of a 7-year-old girl with septic shock caused by necrotizing fasciitis as a complication of varicella. Swelling and pain in the left inguinal region and left axillary region were found five days after varicella. Then a high fever occurred followed by hypotension. Fluid infusion, vasopressor and antibiotics were administered, Group A beta-hemolytic Streptococcus was isolated from exudates from the wounds. The clinical symptoms markedly improved after surgical drainage and removal of the necrotic tissue. Both wounds were covered with skin grafts after healthy granulation tissue formed. Although there have been few reports of life-threatening necrotizing fasciitis following varicella in western countries, it is rare in China. Usually patients with varicella were admitted to pediatric or infectious disease department but not surgical departments; so that the clinicians should be aware that varicella may be complicated by life-threatening surgical infections. Necrotizing fasciitis should be suspected in patients of varicella who showed an increasing pain and swelling in any body areas associated with increasing fever and local erythema. Early identification, surgical drainage and debridement are essential for successful treatment of necrotizing fasciitis.展开更多
Necrotizing fasciitis is a rare complication of chemotherapy,however,few reports were published as a specific complication of taxanes.We are reporting this rare complication of a lady who was treated with taxanes as a...Necrotizing fasciitis is a rare complication of chemotherapy,however,few reports were published as a specific complication of taxanes.We are reporting this rare complication of a lady who was treated with taxanes as an adjuvant therapy for her breast cancer who was referred to us from the medical department and turned out to be necrotizing fasciitis in her right thigh.We are also presenting the literature review of this type of complication.展开更多
BACKGROUND Chronic myelomonocytic leukemia(CMML)complicated with Sweet syndrome(SS)is a rare hematological neoplasm.However,cases of concomitant development of perianal necrotizing SS(NSS)have not been reported.CASE S...BACKGROUND Chronic myelomonocytic leukemia(CMML)complicated with Sweet syndrome(SS)is a rare hematological neoplasm.However,cases of concomitant development of perianal necrotizing SS(NSS)have not been reported.CASE SUMMARY We report a case of a 49-year-old male patient who underwent sequential procedures for hemorrhoids and perianal abscess.He developed postoperative incision infection and was referred to the department where the authors work.Initially,perianal necrotizing fasciitis secondary to incision infection after perianal abscess surgery was suspected.Despite receiving antibiotic therapy and undergoing surgical debridement,deeper necrotic areas formed in the patient’s perianal wounds,accompanied by persistent high fever.Blood and fungal cultures yielded negative results.The final diagnosis was corrected to be CMML with suspected concomitant perianal NSS.CONCLUSION CMML with perianal NSS is a rare condition,often misdiagnosed as perianal abscess or perianal necrotizing fasciitis.Conventional antibiotic therapy and surgical debridement are ineffective in managing this condition.展开更多
<strong>Background:</strong> Within the spectrum of necrotizing soft tissue infections (NSTI), necrotizing fasciitis (NF) has been characterized by tissue and fascial necrosis with systemic toxicity. The o...<strong>Background:</strong> Within the spectrum of necrotizing soft tissue infections (NSTI), necrotizing fasciitis (NF) has been characterized by tissue and fascial necrosis with systemic toxicity. The objective was to determine and summarize the frequency and characteristics of breast NF and NSTI in the literature. <strong>Methods:</strong> Cases were obtained through PubMed, Google Scholar, Google, and from published article reference sections. One hundred twenty-three cases were gleaned from 96 articles that reported NF and NSTI of the breast (1924 through 2021). <strong>Results:</strong> NF was reported in 70 and NSTI in 53 cases (111 women and 12 men). Patients presented with swollen, painful breasts, erythema, bullae, crepitus, necrosis, gangrene, fever, tachycardia, and neutrophilia. Fifty-nine of 123 (48.4%) patients were septic on admission. The most frequent microorganisms were <em>β</em> hemolytic Group A <em>Streptococcus</em>, and <em>Staphylococcus</em><em> aureus</em>. Treatment consisted of antibiotics, mastectomy and debridement with flaps, skin grafts or primary and secondary closure. Forty-four (63.0%) of the NF cases had chest wall involvement;of these, 18 (14.6%) involved the breast secondarily, <em>P</em> < 0.0001. There were twelve mortalities (9.8%): eleven (9.0%) with NF and one (0.8%) with NSTI,<em> P </em>= 0.007. <strong>Conclusions:</strong> Men and women with breast NF and NSTI presented with similar signs and symptoms and required the same emergent treatment as provided for NF and NSTI of the more common sites. As a time-sensitive disease, patients treated within 12 hours of admission had a better survival. Patients with NF were more likely to have sepsis on admission, a higher mortality, and fascial chest wall/muscle involvement than patients with NSTI.展开更多
Acrodermatitis enteropathica is a rare autosomal recessive genetic disorder characterised by periorificial dermatitis, alopecia and diarrhoea. It is caused by a mutation in the gene that codes for a membrane protein t...Acrodermatitis enteropathica is a rare autosomal recessive genetic disorder characterised by periorificial dermatitis, alopecia and diarrhoea. It is caused by a mutation in the gene that codes for a membrane protein that binds zinc. We report a case in a 7-month-old girl, admitted with altered general condition and scaly, pustular erythematous lesions, initially located in the occipital and cervical regions, and secondarily inguinal and on the knees. Management and outcome in this patient? Genetic assay was not available to confirm this rare genetic disease. A delay in establishing the diagnosis and a disastrous outcome did not save the patient despite the administration of zinc.展开更多
In this paper,we analyze the article published by El Labban et al,which explores the impact of cirrhosis on patients with necrotizing fasciitis.The authors conclude that cirrhosis is a significant risk factor for incr...In this paper,we analyze the article published by El Labban et al,which explores the impact of cirrhosis on patients with necrotizing fasciitis.The authors conclude that cirrhosis is a significant risk factor for increased in-hospital morbidity and mortality in this patient population.Building upon their final observation regarding the importance of understanding this association,we will delve into the topic of infections in patients with liver cirrhosis.These patients exhibit intrinsic characteristics that make them particularly susceptible to infections,both bacterial and fungal.This heightened risk not only increases the likelihood of severe infections but also makes them a common trigger for acute decompensations,including the development of acute-on-chronic liver failure,which markedly worsens prognosis and mortality.Infections in patients with cirrhosis often require a more aggressive and rapid diagnostic and therapeutic approach due to the higher risk of nosocomial infections,multidrug-resistant organisms,and atypical clinical presentations.Delayed or inadequate management can lead to unfavorable outcomes,further complicating the course of their underlying liver disease.The aim of this article is to emphasize the importance of early and appropriate management in patients with cirrhosis with infections.Evidence supports that timely and tailored interventions not only improve clinical outcomes but also reduce mortality.By raising awareness among clinicians about the complexity of these cases,we hope to contribute to optimizing the care of this high-risk population.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.
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 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.
文摘BACKGROUND Necrotizing fasciitis(NF)of the upper extremities is a severe surgical pathology,and the incidence of this disease has been steadily increasing in recent decades.Surgical treatment is accompanied by the formation of extensive wounds,which can be treated with significant difficulties.In recent years,negative pressure wound therapy(NPWT)has proven to be highly effective.It is also promising for the treatment of NF.AIM To explore the effectiveness of NPWT in the treatment of NF of the upper extremities.METHODS The results of the treatment of 36 patients with NF of the upper extremities in two groups(NPWT group and control group;2022−2023)were retrospectively analyzed.In the NPWT group,the NPWT method(120 mmHg;constant mode)was used after surgical treatment.The number of vacuum-assisted dressings in patients ranged from 1 to 3,depending on the dynamics of the wound process.The duration of fixation of one bandage was up to 2−3 d.In the control group,conventional methods of local wound treatment were used.The following indicators were analyzed:The treatment delay,the prevalence of inflammation,the microbial landscape,the number of debridements,the duration of wound preparation for surgical closure,and the nature of skin plastic surgery.RESULTS Most patients experienced a significant treatment delay[4 d,interquartile range(IQR):2–7 d],which led to the spread of the pathological process to the forearm and shoulder.The most common pathogens were Staphylococcus aureus(14;38.9%)and Streptococcus pyogenes(22;61.1%).The average number of debridements per patient was 5(IQR:3–7),with no difference between groups.The average time to prepare wounds for surgical closure was 11±4 d in the NPWT group and 29±10 d(P=0.00001)in the control group.In the NPWT group,the wounds were more often closed with local tissues(15;83.3%),and in the control group,split-thickness skin grafts were more often used(4;50%).CONCLUSION The predominant isolation of Staphylococcus aureus and/or Streptococcus pyogenes from the lesions allowed us to classify these patients as NF type II.Multiple debridement procedures have become a feature of this disease treatment.The use of NPWT has significantly reduced the time required to prepare wounds for surgical closure.Early closure of wounds allows for more frequent use of local tissue repair,which ensures better results.NPWT is a highly effective way to prepare wounds for early surgical closure in patients with upper extremity NF.
文摘<b><span>Background:</span></b><span> Necrotizing fasciitis is a rapidly spreading soft tissue infection involving the deep facial layers. It can cause secondary necrosis leading to significant morbidity and mortality. The most important predictor of mortality is a delay in diagnosis. In low income countries, that delay must be high and other predictors of morbidity and mortality must be pointed out. </span><b><span>Objective: </span></b><span>To determine necrotizing fasciitis (NF) prognostic factors in a low income country. </span><b><span>Patients and Methods:</span></b><span> It is a prospective and descriptive study conducted over a one-year period from November 1, 2017 to November 1, 2018 about 23 cases of necrotizing fasciitis in two hospitals of Bujumbura. </span><b><span>Results:</span></b><span> The incidence of necrotizing fasciitis in these 2 hospitals (Kamenge Teaching Hospital and Prince Regent Charles Hospital) was 1%. The average age of patients was 41.76 years. Males were predominant with a sex ratio of 1.55. The risk factors for NF were: NSAIDs in 39%;HIV infection in 13%, diabetes mellitus in 4% and high blood pressure in 4%. The average time from symptoms onset to admission was 17.13 days. The mean time from admission to surgical treatment was 4 days with extremes of 1 to 22 days. The most affected site was the lower limb in 82% of cases. All patients (96%) were treated with necrotic tissue debridement. It was associated with skin grafting in 48% of cases. One patient (4%) with diabetes mellitus and HIV infection was amputated. The mortality rate was 22%</span><span> </span><span>(n = 5). Among those 5 patients, there was a combination of risk factors (diabetes mellitus, NSAID use and HIV infection) in 80% (n = 4), 60% (n = 3) were over 60 years of age and 60% (n = 3) were operated 10 days after the onset of symptoms. The average time of hospital stay was 101 days with extremes of 14 to 400 days. </span><b><span>Conclusion:</span></b><span> Necrotizing fasciitis is associated with a high mortality rate in low income countries. The use of NSAIDs;delayed treatment, elderly and immunosuppressive conditions such as diabetes mellitus and HIV are the most prognostic factors in Bujumbura hospitals.</span>
文摘Emphysematous cholecystitis is a rare subtype of acute cholecystitis characterized by the presence of gas in the gallbladder wall secondary to ischemia. Typically, this is a result of cystic artery vascular compromise with a concomitant infection from gas-forming organisms such as Clostridium species, Klebsiella species, or Escherichia coli. The mortality rate of acute emphysematous cholecystitis is 15% - 20% compared with 1.4% in uncomplicated acute cholecystitis. The subsequent development of a cholecystocutaneous fistula, an abnormal connection between the gallbladder and the skin, is also a rare complication of gallbladder disease. We describe a case of a 77-year-old male who presented with right flank necrotizing fasciitis which developed from a cholecystocutaneous fistula secondary to emphysematous cholecystitis. Once the necrotic tissues were adequately debrided, the large open wound was treated with negative pressure wound therapy with instillation (NPWT-i) utilizing hypochlorous acid (HOCL). The wound was closed with a split-thickness skin graft.
文摘Objective: to deeply analyze the nursing effect of perianal abscess combined with perineal necrotizing fasciitis. Methods: from April 2018 to August 2019, 22 patients with perianal abscess combined with perineal necrotizing fasciitis admitted to our hospital were selected as the subjects of this study. After treatment and nursing, the nursing effect was evaluated. Results: all patients were cured after treatment and nursing, with a 100% success rate of treatment, and there was no complication or functional failure. Conclusion: patients with perianal abscess combined with perineal necrotizing fasciitis not only have a relatively urgent condition, but also develop rapidly, accompanied by more complications, which is easy to lead to death of patients. Effective nursing measures should be taken in clinical practice to reduce the rate of disability and mortality of patients after operation, which can be widely used in clinical treatment.
文摘This article discusses a case of perianal necrotizing fasciitis from perianal abscess with integrated Chinese and western medicine treatment.It has been concluded that the treatment of perianal necrotizing fasciitis from perianal abscess should focus on dispelling evil,tonifying deficiency,or attack and supplement at the same time in order to achieve the purpose of dispelling evil without harming the right while supporting the right without leaving evil.
文摘Necrotizing fasciitis (FN) are severe, fulminant infection with necrosis of the skin and superficial fascia. The variability of the clinical picture and the severity of the condition make it a formidable condition. B.A, 16 years old, breeder, was admitted to ENT hospitalization for a large necrotic cervico-thoracic and dorsal ulceration of sudden onset following febrile odynophagia. ENT examination: large necrotic wound extending from the antero-posterior cervical region to the thoraco-abdominal and dorsal region, letting pus weld with trismus at 1.5 cm and a fistula of the anterior pillar of the right tonsil. Cytobacteriological examination of the pus isolated Staphylococcus aureus. We instituted a probabilistic antibiotic therapy readjusted afterward to the association amoxicillin clavulanic acid with the result of the antibiogram. Incision, drainage and surgical debridement of all necrotic tissues were performed, leading to extensive loss of skin substance. A daily local dressing was applied for 11 days, then replaced by honey for 51 days. On the 64th day, he was entrusted to the dermatology department for a skin graft where he stayed for 3 months. Conclusion: current name, necrotizing bacterial dermohypodermatitis. Surgery has a key role in treatment. Antibiotic therapy should be broad-spectrum.
文摘Necrotizing fasciitis(NF)caused by vibrio vulnificus(VV)is a rare but fatal clinical emergency characterized by hemorrhagic bullous skin lesions,septic shock and multiple organ dysfunction syndrome(MODS),commonly occurring in patients with chronic liver disease.1,2 In general,mortality of these patients is higher than 60%,which could approach 100%when complicated with septic shock.Therefore,early diagnosis and effectively surgical intervention in emergency room are the mainstays for better outcomes of these patients.However,many emergency physicians lack experiences in diagnosing and managing vibrio NF.Furthermore,due to the preexisting severe medical complications including hypotension,lactic acidosis,coagulation disorders and thrombocytopenia,the optimal therapeutic strategies for these critical patients should obviously be evaluated on a patient-to-patient basis,which remains largely undefined.
文摘Varicella is a self-limited disease, but sometimes it may be associated with some serious life-threatening complications. Necrotizing fasciitis is a rare complication of varicella. This is a case of a 7-year-old girl with septic shock caused by necrotizing fasciitis as a complication of varicella. Swelling and pain in the left inguinal region and left axillary region were found five days after varicella. Then a high fever occurred followed by hypotension. Fluid infusion, vasopressor and antibiotics were administered, Group A beta-hemolytic Streptococcus was isolated from exudates from the wounds. The clinical symptoms markedly improved after surgical drainage and removal of the necrotic tissue. Both wounds were covered with skin grafts after healthy granulation tissue formed. Although there have been few reports of life-threatening necrotizing fasciitis following varicella in western countries, it is rare in China. Usually patients with varicella were admitted to pediatric or infectious disease department but not surgical departments; so that the clinicians should be aware that varicella may be complicated by life-threatening surgical infections. Necrotizing fasciitis should be suspected in patients of varicella who showed an increasing pain and swelling in any body areas associated with increasing fever and local erythema. Early identification, surgical drainage and debridement are essential for successful treatment of necrotizing fasciitis.
文摘Necrotizing fasciitis is a rare complication of chemotherapy,however,few reports were published as a specific complication of taxanes.We are reporting this rare complication of a lady who was treated with taxanes as an adjuvant therapy for her breast cancer who was referred to us from the medical department and turned out to be necrotizing fasciitis in her right thigh.We are also presenting the literature review of this type of complication.
基金Supported by the National Key Research and Development Program of China,No.2021YFC2009100Included in the information database of“Pelvic Diaphragm Health Archives”,No.2021YFC2009103.
文摘BACKGROUND Chronic myelomonocytic leukemia(CMML)complicated with Sweet syndrome(SS)is a rare hematological neoplasm.However,cases of concomitant development of perianal necrotizing SS(NSS)have not been reported.CASE SUMMARY We report a case of a 49-year-old male patient who underwent sequential procedures for hemorrhoids and perianal abscess.He developed postoperative incision infection and was referred to the department where the authors work.Initially,perianal necrotizing fasciitis secondary to incision infection after perianal abscess surgery was suspected.Despite receiving antibiotic therapy and undergoing surgical debridement,deeper necrotic areas formed in the patient’s perianal wounds,accompanied by persistent high fever.Blood and fungal cultures yielded negative results.The final diagnosis was corrected to be CMML with suspected concomitant perianal NSS.CONCLUSION CMML with perianal NSS is a rare condition,often misdiagnosed as perianal abscess or perianal necrotizing fasciitis.Conventional antibiotic therapy and surgical debridement are ineffective in managing this condition.
文摘<strong>Background:</strong> Within the spectrum of necrotizing soft tissue infections (NSTI), necrotizing fasciitis (NF) has been characterized by tissue and fascial necrosis with systemic toxicity. The objective was to determine and summarize the frequency and characteristics of breast NF and NSTI in the literature. <strong>Methods:</strong> Cases were obtained through PubMed, Google Scholar, Google, and from published article reference sections. One hundred twenty-three cases were gleaned from 96 articles that reported NF and NSTI of the breast (1924 through 2021). <strong>Results:</strong> NF was reported in 70 and NSTI in 53 cases (111 women and 12 men). Patients presented with swollen, painful breasts, erythema, bullae, crepitus, necrosis, gangrene, fever, tachycardia, and neutrophilia. Fifty-nine of 123 (48.4%) patients were septic on admission. The most frequent microorganisms were <em>β</em> hemolytic Group A <em>Streptococcus</em>, and <em>Staphylococcus</em><em> aureus</em>. Treatment consisted of antibiotics, mastectomy and debridement with flaps, skin grafts or primary and secondary closure. Forty-four (63.0%) of the NF cases had chest wall involvement;of these, 18 (14.6%) involved the breast secondarily, <em>P</em> < 0.0001. There were twelve mortalities (9.8%): eleven (9.0%) with NF and one (0.8%) with NSTI,<em> P </em>= 0.007. <strong>Conclusions:</strong> Men and women with breast NF and NSTI presented with similar signs and symptoms and required the same emergent treatment as provided for NF and NSTI of the more common sites. As a time-sensitive disease, patients treated within 12 hours of admission had a better survival. Patients with NF were more likely to have sepsis on admission, a higher mortality, and fascial chest wall/muscle involvement than patients with NSTI.
文摘Acrodermatitis enteropathica is a rare autosomal recessive genetic disorder characterised by periorificial dermatitis, alopecia and diarrhoea. It is caused by a mutation in the gene that codes for a membrane protein that binds zinc. We report a case in a 7-month-old girl, admitted with altered general condition and scaly, pustular erythematous lesions, initially located in the occipital and cervical regions, and secondarily inguinal and on the knees. Management and outcome in this patient? Genetic assay was not available to confirm this rare genetic disease. A delay in establishing the diagnosis and a disastrous outcome did not save the patient despite the administration of zinc.
文摘In this paper,we analyze the article published by El Labban et al,which explores the impact of cirrhosis on patients with necrotizing fasciitis.The authors conclude that cirrhosis is a significant risk factor for increased in-hospital morbidity and mortality in this patient population.Building upon their final observation regarding the importance of understanding this association,we will delve into the topic of infections in patients with liver cirrhosis.These patients exhibit intrinsic characteristics that make them particularly susceptible to infections,both bacterial and fungal.This heightened risk not only increases the likelihood of severe infections but also makes them a common trigger for acute decompensations,including the development of acute-on-chronic liver failure,which markedly worsens prognosis and mortality.Infections in patients with cirrhosis often require a more aggressive and rapid diagnostic and therapeutic approach due to the higher risk of nosocomial infections,multidrug-resistant organisms,and atypical clinical presentations.Delayed or inadequate management can lead to unfavorable outcomes,further complicating the course of their underlying liver disease.The aim of this article is to emphasize the importance of early and appropriate management in patients with cirrhosis with infections.Evidence supports that timely and tailored interventions not only improve clinical outcomes but also reduce mortality.By raising awareness among clinicians about the complexity of these cases,we hope to contribute to optimizing the care of this high-risk population.
