Authors
Nebojša Marić12, Ljubinko Đenić1, Aleksandar Ristanović1, Nataša Vešović1, Vanja Kostovski1, Dejan Stojković1,Milena Pandrc3, Bojana Miranović1, Vlado Cvijanović1,2
1Klinika za grudnu hirurgiju, Vojnomedicinska akademija, Beograd
2Medicinski fakultet, Vojnomedicinska akademija, Univerzitet odbrane, Beograd
3Klinika za urgentnu medicine, Vojnomedicinska akademija, Beograd
• Rad je primljen 07.06.2016. / Prihvaćen 15.06.2016.
Correspodernce to:
assist. dr Nebojša Marić,
e-mail: maricvma@gmail.com
Abstract
Necrotizing fasciitis (NF) is life-threatening, rapidly progressive infection that primarily affects the superficial fascia, with expanding into the subcutaneous adipose tissue, skin, muscles causing their necrosis. Unrecognized or inadequately treated can lead to the development of septic shock, multiple organs dysfunctional syndrome (MODS) and lethal outcome. In this paper we presented three patients treated in the Department of Thoracic Surgery of the MilitaryMedicalAcademy in the last 4 years. Based on clinical and biohumoral parameters and radiological examinations we had the suspicion of NF that is, in the further course, morphological proved.Emergency surgical intervention with administration of antibiotics - cephalosporin of third and fourth generation and supportive therapy is the primary modality NF's treatement. During the therapy, the improvement of general condition, normalization of markers of inflammation with satisfactory local findings were achieved. In one patient the postoperative hyperbaric oxygenation (HBO) and VAC (negative pressure) therapy had influence upon the length of hospitalization. Necrotizing fasciitis is a rare, often unexpected, but very serious infection that can be fatal finished in a very short period of time. In a large percentage of patients, in the initial stage, disease could be misdiagnosed as cellulitis or abscess.It should be noted that the NF should be suspected in any patient presenting with infection, soft tissue swelling and pain that does not correlate with physical findings especially in cases of progression of infection despite the use of broad spectrum antibiotics. Early diagnosis and comprehensive therapeutic approach are crucial to the success of treatment.
Key words
necrotizing fasciitis, surgery, hyperbaric oxygenation, VAC Therapy
References
- File T, Tan J, Dipersio J, Diagnosing and treating the flesh-eating bacteriasyndrome, Cleve. Clin. J. Med, 1988; 65:241-9.
- Jallali N, Necrotising fasciitis: its aetiology, diagnosis and management. J. Wound. Care, 2003;12:297–300.
- Sendi P, Johansson L, Norrby-Teglund A, Invasive Group B streptococcal disease in non-pregnant adults: a review with emphasis on skin and soft-tissue infections, Infection, 2008;36:100–11.
- Wang KC, Shih CH, Necrotizing fasciitis of the extremities, J. Trauma, 1992;32:179–82.
- Descamps V, Atiken J, Lee M, Hippocrates on necrotizing fasciitis,Lancet,1994; 344(8921): 556.
- Sarani B, Strong M, Pascual J, Schwab WC, Necrotizing fasciitis: current concepts and review of the literature, J. Am. Coll. Surg, 2009;208(2):279−88.
- Sarna T, Sengupta T, Miloro M, Kolokythas A, Cervical necrotiz-ing fasciitis with descending mediastinitis: literature review and case report, J. Oral Maxillofac. Surg, 2012;70(6):1342−50.
- Mikić D, Bojić I, Djokić M, Stanić V, Stepić V, Mićević D, Rudnjanin S, Radosavljević A, Mićić J, Tomanović B, Begović V, Popović S, Necrotizing fasciitis caused by group A streptococcus, Vojnosanit. Pregl, 2002; 59(2): 203−7.
- Das DK, Baker MG, Venugopal K, Increasing incidence of ne-crotizing fasciitis in New Zealand: a nationwide study over the period 1990 to 2006. J Infect 2011; 63(6):429−33.
- Kao LS, Lew DF, Arab SN, Todd S, Awad SS, Carrick MM, Corneille MG, Lally KP, Local variations in the epidemiology, microbiology, and out-come of necrotizing soft-tissue infections: a multicenter study, Am. J. Surg, 2011;202(2):139−45.
- Kaul R, McGeer A, Low DE, Green K, Schwartz B,Population based surveillance for group A streptococcal necrotizing fasciitis: clinical features, prognostic indicators, and microbiologic analysis of seventy-seven cases. Ontario Group A Streptococcal Study,Am. J. Med,1997;103:18–24.
- Anaya DA, Dellinger EP,Necrotizing soft-tissue infection: diagnosis and management. Clin. Infect. Dis,2007;44:705–10.
- Anaya DA, McMahon K, Nathens AB,Predictors of mortality and limb loss in necrotizing soft tissue infections,Arch. Surg, 2005;140:151–7.
- Goh T, Goh LG, Ang CH, Wong CH,Early diagnosis of necrotizing fasciitis,Br. J. Surg, 2014;101:119–25
- Martinschek A, Evers B, Lampl L, Gerngroß H, Schmidt R, Sparwasser C,Prognostic aspects, survival rate, and predisposing risk factors in patients with Fournier’s gangrene and necrotizing soft tissue infections: evaluation of clinical outcome of 55 patients,Urol. Int, 2012;89:173–9.
- Wong C, Chang H, Pasupathy S, Khin L, Tan J, Low C, Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality,J. Bone Joint. Surg. Am,2003; 85-A:1454–60.
- Morgan MS,Diagnosis and management of necrotising fasciitis: a multiparametric approach,J. Hosp. Infect,2010;75:249–57.
- Gauzit R,Necrotizing skin and soft tissue infections: definitions, clinical and microbiological features,Ann. Fr. Anesth. Reanim, 2006;25:967–70.
- Bakleh M, Wold LE, Mandrekar JN, Harmsen WS, Dimashkieh HH, Baddour LM,Correlation of histopathologic findings with clinical outcome in necrotizing fasciitis,Clin Infect. Dis, 2005;40:410–14
- Mikić D, Bojić I, Necrotizing fasciitis, Vojnosanit. Pregl, 2000;57(3):339−45.
- Shimizu T, Tokuda Y,Necrotizing fasciitis,Intern. Med, 2010;49:1051–7.
- Wong C, Khin L, Heng K, Tan K, Low C, The LRINEC (Labora-tory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infec-tions, Crit. Care. Med, 2004; 32(7):1535−41.
- Lancerotto L, Tocco I, Salmaso R, Vindigni V, Bassetto F, Necrotising fasciitis: classification, diagnosis, and management,J. Trauma Acute Care Surg,2012;72:560–6.
- Zimbelman J, Palmer A, Todd J,Improved outcome of clindamycin compared with beta-lactam antibiotic treatment for invasive Streptococcus pyogenes infection,Pediatr. Infect. Dis. J, 1999;18:1096-100.
- Evangelos P. M. ,George B.,Paul P, Dimitrios S, Prodromos K, Anastasios M, Current Concepts in the Management of Necrotizing Fasciitis,Front. Surg. 2014; 1:36.
- O'Brien CD, Manaker S: Hyperbaric oxygen therapy. In: UpToDate? Version 11.1. UpToDate, Wellesley, MA 2003.
- Clark LA, Moon RE, Hyperbaric oxygen in the treatment of lifethreatening soft-tissue infections, Respir. Care Clin. N. Am, 1999; 5:203-19.
- Silberstein J, Grabowski J, Parsons JK,Use of a vacuum-assisted device for Fournier’s gangrene: a new paradigm,Rev. Urol,2008;10:76–80.
- Moues CM, van den Bemd GJ, Heule F, Hovius SE,Comparing conventional gauze therapy to vacuum-assisted closure wound therapy: a prospective randomised trial,J. Plast. Reconstr. Aesthet. Surg,2007;60:672–81.
PDF Maric N. et al • MD-Medical Data 2016;8(2) 133-138