Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbsReportar como inadecuado




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World Journal of Emergency Surgery

, 6:46

First Online: 23 December 2011Received: 29 July 2011Accepted: 23 December 2011

Abstract

Necrotizing fasciitis NF is an uncommon soft tissue infection, usually caused by toxin-producing virulent bacteria. It is characterized by widespread fascial necrosis primarily caused by Streptococcus hemolyticus. Shortly after the onset of the disease, patients become colonized with their own aerobic and anaerobic microflora from the gastrointestinal and-or urogenital tracts. Early diagnosis with aggressive multidisciplinary treatment is mandatory. We describe three clinical cases with NF. The first is a 69 years old man with diabetes mellitus type II, who presented with NF on the posterior chest wall, shoulder and arm. He was admitted to the intensive care unit ICU with a clinical picture of severe sepsis. Outpatient treatment and early surgical debridement of the affected zones inside 3 hours after admittance and critical care therapy were performed. The second case is of a 63 years old paraplegic man with diabetes mellitus type I. Pressure sores and perineal abscesses progressed to Fournier-s gangrene of the perineum and scrotum. He had NF of the anterior abdominal wall and the right thigh. Outpatient treatment and early surgical debridement of the affected zones inside 6 hour after admittance and critical care therapy were performed. The third patient was a 56 year old man who had NF of the anterior abdominal wall, flank and retroperitoneal space. He had an operation of the direct inguinal hernia, which was complicated with a bowel perforation and secondary peritonitis. After establishing the diagnosis of NF of the abdominal wall and retroperitoneal space RS, he was transferred to the ICU. There he first received intensive care therapy, after which emergency surgical debridement of the abdominal wall, left colectomy, and extensive debridement of the RS were done 72 hours after operation of inquinal hernia. On average, 4 serial debridements were performed in each patient. The median of serial debridement in all three cases was four times. Other intensive care therapy with a combination of antibiotics and adjuvant hyperbaric oxygen therapy HBOT was applied during the treatment. After stabilization of soft tissue wounds and the formation of fresh granulation tissue, soft tissue defect were reconstructed using simple to complex reconstructive methods.

AbbreviationsABantibiotics

ATAatmospheres absolute pressure

AWabdominal wall AWD: abdominal wall defect

CRPC-reactive protein

CWchest wall

DMDiabetes mellitus

GPGeneral practitioner

HBOTHyperbaric oxygen therapy

ICUIntensive care unit

LRINEClaboratory risk indictor for necrotizing fasciitis

MODSmultiple organ dysfunction syndrome

MRSAmeticillin resistant Staphylococcus aureus

NFNecrotizing fasciitis

NSTIsNecrotizing soft tissue infections

PMNsPolymorphonuclear neutrophils

RSretroperitineal space

SGskin graft

SIRSsystemic inflammatory response syndrome

SSTIsSkin and soft tissue infections

TNPTopical negative pressure.

Electronic supplementary materialThe online version of this article doi:10.1186-1749-7922-6-46 contains supplementary material, which is available to authorized users.

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Autor: Zdravko Roje - Željka Roje - Dario Matić - Davor Librenjak - Stjepan Dokuzović - Josip Varvodić

Fuente: https://link.springer.com/







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