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Necrotizing Fasciitis: Case Reports and Literature Review

Necrotizing Fasciitis: Case Reports and Literature Review. 台北市立萬芳醫院 整形外科 張瓊文醫師. Necrotizing Fasciitis. 1883 Fournier Rapidly progressive necrotizing infection of scrotum – Fournier’s gangrene 1924 Meleney – necrotizing fasciitis Bacterial synergism Necrotizing soft tissue infection:

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Necrotizing Fasciitis: Case Reports and Literature Review

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  1. Necrotizing Fasciitis: Case Reports and Literature Review 台北市立萬芳醫院 整形外科 張瓊文醫師

  2. Necrotizing Fasciitis • 1883 Fournier • Rapidly progressive necrotizing infection of scrotum – Fournier’s gangrene • 1924 Meleney – necrotizing fasciitis • Bacterial synergism • Necrotizing soft tissue infection: • A rapidly progressive soft tissue infection involving necrosis of the SubQ tissue, superficial and deep fascia and sometimes the underlying muscles

  3. Necrotizing Fasciitis • Predisposing factors: • advanced age, trauma, DM, immunosuppression, chronic systemic diseases ( HTN, ESRD, atherosclerosis ) • Multiple etiology • Bacteriology: polymicrobial

  4. Necrotizing Fasciitis • Key to successful treatment: • Early diagnosis • Broad-spectrum antibiotics • Prompt and adequate surgical debridement and/or fasciotomy

  5. Necrotizing Fasciitis • Diagnosis: • Traditional infection signs – reddness, swelling, local heat and tenderness • Marked edema extending beyond erythema • Bullae foremation(hemorrhagic) • Crepitis • Radiologic evidence of gas within tissues • Rapidly progressive infection

  6. Necrotizing Fasciitis • Treatment: • Prompt and adequate debridement and fasciotomy • Modalities of Reconstruction: • Primary closure • Amputation ( BK or AK ) • STSG • Tissue expander • Flap reconstruction

  7. Necrotizing Fasciitis • Need to be discussed: • Bacteriology – varied with location and etiology ( esp. DM) • Antibiotic evolution and the effect of cutting-edge antibiotics change the course of the diseases • Adequate surgical debridement speed up the recovery and reduce hospital stay (average 2 weeks)

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