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Necrotizing Fasciitis: A Surgical and Medical Emergency

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DOI: 10.4236/ss.2012.311103    6,735 Downloads   9,839 Views   Citations

ABSTRACT

Necrotizing fasciitis (NF) is still remained a dreaded disease with high morbidity and mortality due to rapidly progressive necrotizing infection. Objective: Review recent available literature on necrotizing fasciitis (NF) and compare it with our publications. Data and Source: Local and international published literature on NF from early nineties to 2012; Midline and pub Med literature search using the term “necrotizing fasciitis”. Data Synthesis: NF is more common in male patient, it is frequently polymicrobial. Common site of NF is the extremities. NF is classified according to the microbes. Common co-morbid condition associated with NF is diabetes mellitus. Minor trauma and surgery are the major etiological risk factors for NF. There seems to be significant correlation between the use of non steroidal anti-inflammatory medication (NSAID) and NF. Severe pain disproportionate to injury is the presenting symptom. Laboratory risk indicators for necrotizing fasciitis (LRINEC) score will diagnose NF early in emergency clinics. Tissue biopsy is the gold standard for the diagnosis of NF. Pathophysiology of NF is rapid horizontal spread of infection with fascial necrosis and secondary vertical involvement of skin. More than 90% of NF patients need intensive care therapy. Early and bold debridement in combination with brave organ supportive intensive care will have better outcome of NF patients. Conclusion: High index of suspicion and knowledge is essential for early diagnosis of NF. Finger test and LRINEC score may help in early diagnosis. Early debridement, proper antibiotics and organ supportive intensive care will improve morbidity and mortality of NF patients.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

N. Shaikh, J. Khawaiter and H. Al-Thani, "Necrotizing Fasciitis: A Surgical and Medical Emergency," Surgical Science, Vol. 3 No. 11, 2012, pp. 518-525. doi: 10.4236/ss.2012.311103.

References

[1] M. S. Morgan, “Diagnosis and Management of Necrotizing Fasciitis,” Journal of Hospital Infection, Vol. 75, No. 4, 2010, pp. 249-257. doi:10.1016/j.jhin.2010.01.028
[2] J. P. Y. Cheung, B. Fung, W. M. Tang and W. Y. Ip, “A Review of Necrotizing Fasciitis in the Extremities,” Hong Kong Medical Journal, Vol. 15, No. 1, 2009, pp. 44-52.
[3] B. Wilson, “Necrotizing Fasciitis,” The American Journal of Surgery, Vol. 18, No. 4, 1952, pp. 416-431.
[4] Miller et al., “Necrotizing Fasciitis Caused by Community Associated Methicilin Resistant Staphylococcal Infection in LA,” The New England Journal of Medicine, Vol. 352, No. 14, 2005, pp. 1445-1453. doi:10.1056/NEJMoa042683
[5] H. Saiidy, P. Matteucci, P. R. W. Stanley and N. B. Hart, “Necrotizing Fasciitis,” British Medical Journal, Vol. 330, No. 7495, 2005, pp. 830-833.
[6] N. Shaikh, “Necrotizing Fasciitis, a Decade of Surgical Intensive Care Experience,” Indian Journal of Critical Care Medicine, Vol. 10, No. 4, 2006, pp. 225-229.
[7] D. A. Anaya, K. McMahon, A. B. Nathens, S. R. Sullivan, H. Foy and E. Bugler, “Predictors of Mortality and Limb Loss in Necrotizing Soft Tissue Infections,” Archives of Surgery, Vol. 140, No. 2, 2005, pp. 151-157. doi:10.1001/archsurg.140.2.151
[8] N. Shaikh and A. Rashid, “Regional Necrotizing Fasciitis and Its Outcome,” Qatar Medical Journal, Vol. 17, No. 1, 2008, pp. 24-27.
[9] S. Ozturk, F. Zur, Y. Karslioglu and M. Sengezer, “Idiopathic Neonatal Necrotizing Fasciitis of Scalp. A Case Report,” European Journal of Plastic Surgery, Vol. 28, No. 5, 2005, pp. 368-370. doi:10.1007/s00238-005-0801-8
[10] K. H. Goodell, M. R. Jordan, R. Graham, et al., “Rapidly Advancing NF Caused by Phytobacterium (Vibrio). A Hyper Aggressive Variant,” Critical Care Medicine,Vol. 32, No. 1, 2004, pp. 278-281. doi:10.1097/01.CCM.0000104920.01254.82
[11] N. Shaikh, M. A. kattern and A. Ahmed, “Necrotizing Fasciitis Caused by Aeromonas sabori,” The Middle East Journal of Emergency Medicine, Vol. 7, 2007, pp. 30-32.
[12] C. Souyri, P. Oliver, S. Grolleau and M. Lapeyre-Mastre, “French Network of Pharmaco-Vigilance Centers. Severe soft Tissue Infections and Non-Steroidal Anti-Inflammmatory Drugs,” Clinical and Experimental Dermatology, Vol. 33, No. 3, 2008, pp. 249-255. doi:10.1111/j.1365-2230.2007.02652.x
[13] I. Brook and E. H. Frazier, “Clinical and Microbiological Features of Necrotizing Fasciitis,” Journal of Clinical Microbiology, Vol. 33, No. 9, 1995, pp. 2382-2387.
[14] W. M. Tang, P. L. Ho, K. K. Fung, K. Y. Yen and J. C. Leong, “Necrotizing Fasciitis of a Limb,” Journal of Bone & Joint Surgery, British Volume, Vol. 83, No. 5, 2001, pp. 709-714. doi:10.1302/0301-620X.83B5.10987
[15] Y. S. Wang, et al., “Staging of Necrotizing Fasciitis Based on the Evolving Cutaneous Features,” International Journal of Dermatology, Vol. 46, No. 10, 2007, pp. 1036-1040. doi:10.1111/j.1365-4632.2007.03201.x
[16] C. H. Wong, L. W. Khin, K. S. Heng, et al., ”The LRINEC (Laboratory Risk Indicatotors for Necrotizing Fasciitis) Score. A Tool for Distinguish Necrotizing Fasciitis from Cellulites,” Critical Care Medicine, Vol. 32, 2004, pp. 1535-1540. doi:10.1097/01.CCM.0000129486.35458.7D
[17] T. L. Wong and C. L. Hung, “Role of Tissue Oxygen Monitoring in Diagnosing Necrotizing Fasciitis of Lower Limbs,” Annals of Emergency Medicine, Vol. 44, No. 3, 2004, pp. 222-228. doi:10.1016/j.annemergmed.2004.03.022
[18] G. C. Parenti, C. Marri, G. Calandra, C. Morisi and W. Zabberoni, “Necrotizing Infection of Soft Tissue. Role of Diagnostic Imaging and Review of Literature,” Radiologia Medica (Torino), Vol. 99, 2000, pp. 334-339.
[19] H. C. Chao, M. S. Kong and T. Y. Lin, “Diagnosis of Necrotizing Fasciitis in Children,” Journal of Ultrasound in Medicine, Vol. 18, 1999, No. 277-278.
[20] M. G. Wysoki, et al., “Necrotizing fasciitis: CT characteristics,” Radiology, Vol. 203, No. 3, 1997, pp. 859-863.
[21] M. R. Schmid, et al., “Differentiation of Necrotizing Fasciitis from Cellulitis, Using MR Imaging,” American Journal of Roentgenology, Vol. 170, 1998, pp. 615-620.
[22] T. J. Andreasen, et al., “Massive Soft Tissue Injury: Diagnosis and Management of Necrotizing Fasciitis and Purpura Fulminans,” Plastic and Reconstructive Surgery, Vol. 107, 2001, pp. 1025-1035. doi:10.1097/00006534-200104010-00019
[23] J. Majeski and E. Majeski, “Necrotizing Fasciitis: Improved Survival with Early Recognition by Tissue Biopsy and Aggressive Debridement,” Southern Medical Journal, Vol. 90, No. 11, 1997, pp. 1065-1068. doi:10.1097/00007611-199711000-00001
[24] D. V. Seal, “Necrotizing Fasciitis,” Current Opinion in Infectious Diseases, Vol. 14, No. 2, 2001, pp. 127-132. doi:10.1097/00001432-200104000-00003
[25] B. Sarani, et al., “Necrotizing Fasciitis: Current Concepts and Review of the Literature,” Journal of the American College of Surgeons, Vol. 208, No. 2, 2009, pp. 279-288. doi:10.1016/j.jamcollsurg.2008.10.032
[26] U. I. Ugboko, E. Assam, F. O. Oginni and A. O. Amole, “Necrotizing Fasciitis of Head and Neck: A Review of Literature,” Nigerian Medical Journal, Vol. 10, No. 1, 2001, pp. 6-10.
[27] S. T. Lille, T. T. Sato, L. H. Engrave, H. Foy and G. J. Jurkovich, “Necrotizing Soft Tissue Infection: Obstacles in Diagnosis,” Journal of the American College of Surgeons, Vol. 182, 1996, pp. 7-11.
[28] B. D. Bilton, G. B. Zibari, R. W. McMillan, D. F. Aultman, G. Dunn and J. C. McDonald, “Aggressive Surgical Management of Necrotizing Fasciitis Serves to Decrease Mortality. A Retrospective Study,” Annals of Surgery, Vol. 64, No. 5, 1998, pp. 397-400.
[29] Z. Roje, Z. Roje, D. Matic, D. Librenjak, S. Dokuzovic, J. Varvodic, “Necrotizing Fasciitis: Literature Review of Contemporary Strategies for Diagnosis and Management: Three Case Reports: Tarso, Abdominal Wall, Upper and Lower Limbs,” World Journal of Emergency Surgery, Vol. 6, 2011, p. 46. doi:10.1186/1749-7922-6-46
[30] R. F. Edlich, K. L. Winters, C. R. Woodard, L. D. Britt and W. B. Long, “Massive Soft Tissue Infections: Necrotizing Fasciitis and Purpura Fulminans,” Journal of Long-Term Effects of Medical Implants, Vol. 15, No. 1, 2005, pp. 57-65. doi:10.1615/JLongTermEffMedImplants.v15.i1.70
[31] R. Kaul, A. McGeer, et al., “Intravenous Immunoglobulin Therapy for Streptococcal Toxic Shock Syndrome—A Comparative Observational Study,” Clinical Infectious Diseases, Vol. 28, No. 4, 1999, pp. 800-807. doi:10.1086/515199
[32] M. Hassell, P. Fagan, P. Carson, B. J. Currie, “Streptococcal Pyogens Necrotizing Fasciitis from Diverse Strains in Tropical Northern Australia. Comparison with the Literature,” BMC Infectious Diseases, Vol. 4, No. 1, 2004, p. 60. doi:10.1186/1471-2334-4-60
[33] B. J. Childers, L. D. Potyondy, R. Nachreiner, et al., “Necrotizing Fasciitis: A Fourteen Years Retrospective Study of 163 Consecutive Patients,” The American Journal of Surgery, Vol. 68, No. 2, 2002, pp. 109-116.
[34] L. K. Weaver, “Hyperbaric Oxygen Therapy in Critically Ill,” Critical Care Medicine, Vol. 39, 2011, pp. 1784-1791. doi:10.1097/CCM.0b013e31821858d1
[35] S. J. Mathes, P. M. Steinwald, R. D. Foster, W. Y. Hoffman and J. P. Anthony, “Complex Abdominal Wall Reconstruction: A Comparison of Flap and Mesh Closure,” Annals of Surgery, Vol. 232, No. 4, 2000, pp. 586-596. doi:10.1097/00000658-200010000-00014
[36] M. Ozalay, G. Ozkoc, S. Akpinar, M. A. Hersekli and R. N. Tandogan, “Necrotizing Soft Tissue Infection of a Limb. Clinical Presentationand Factors Related to Mortality,” Foot and Ankle International, Vol. 27, No. 8, 2006, pp. 598-605.
[37] G. Mouzopoulos, M. Stamatakos, S. Tzurbak, et al., “Lower Extremity Infections by Vibrio Vulrificus,” Chirugia, Vol. 96, 2006, pp. 868-605.
[38] A. El-Menyar and N. Shaikh, “Necrotizing Fasciitis Causing Severe Myocardial Dysfunction with ST-Segment Elevation in a Young Man,” American Journal of Emergency Medicine, Vol. 28, No. 2, 2010, pp. 260 e3-260 e5.
[39] N. Shaikh, “Necrotizing Fasciitis and Diabetes Mellitus,” International Journal of Diabetes in Developing Countries, Vol. 27, 2007, pp. 15-17.
[40] C. M. Ogilvie and T. Miclau, “Necrotizing Soft Tissue Infections of the Extremities and Back,” Clinical Orthopaedics and Related Research, Vol. 447, 2006, pp. 179-186. doi:10.1097/01.blo.0000218734.46376.89
[41] C. T. Hsiao, H. H. Weng, Y. D. Yuan, C. T. Chen and I. C. Chen, “Predictors of Mortality in Patients with Necrotizing Fasciitis,” The American Journal of Emergency Medicine, Vol. 26, No. 2, 2008, pp. 170-175. doi:10.1016/j.ajem.2007.04.023
[42] www.hkma.org/english/cme/onlinecme/cme201206set.htm
[43] Group A Streptococcal (GAS) Disease, Center for Disease Control and Prevention. Http/www.cdc.gov/ncidod/dbmd/diseaseinf/groupastreptococal.g.htm

  
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