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Necrotizing Soft Tissue Infections

Wheeless' Textbook of Orthopaedics - necrotizing fascitits is any necrotizing soft tissue infection spreading along fascial planes, with or without overlying cellulitis; - also called Meleney ulcer, NF is severe manifestation of lymphangitis that progresses in a frightening manner within a few hours; - tissue necrosis develops rapidly behind advancing wall of inflammation that limits penetration by antibiotics; - desquamation followed by gangrene may be relentless; - clinical signs of pain, hyperyrexia, and chills are severe; - skin lesions are incised and drained or aspirated to obtain fluid for culture; - initial findings are localized pain and minimal swelling, often w/ no visible trauma or discoloration of the skin; - dermal induration and erythema eventually become evident; - eventually the patient has limited range of motion, chills, fever; - dx is confirmed when a probed can be passed laterally along fascial cleft in a open wound; - blistering of the epidermis is a late finding;

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Bone Joint And Necrotizing Soft Tissue Infections

Medical Microbiology Section 5. Introduction to Infectious Diseases 100. Bone, Joint, and Necrotizing Soft Tissue Infections Jon T. Mader Jason Calhoun General Concepts Sections include:- Introduction Necrotizing Soft Tissue Infections Crepitant Anaerobic Cellulitis Necrotizing Fasciitis Nonclostridial Myonecrosis Clostridial Myonecrosis Fungal Necrotizing Cellulitis Joint Infections Gonococcal Arthritis Nongonococcal Arthritis Diagnosis of Bacterial Arthritis Granulomatous Arthritis Bone Infections Hematogenous Osteomyelitis Contiguous-Focus Osteomyelitis Chronic Osteomyelitis Diagnosis of Bacterial Osteomyelitis Skeletal Tuberculosis Fungal Osteomyelitis References

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Clinical And Micromiological Features Of Necrotizing Fasciitis

Full text article Journal of Clinical Microbiology Sept 1995 p2382-2387

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Combination Of Hbo And Negative Pressure Therapy To Prevent Mortality In Patients With Necrotizing Fasciitis

Poster. Weber et al, Aurora Health Care and Hyperbaric and Wound Care Associates, Milwaukee

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Flesh Eating Disease A Note On Necrotizing Fasciitis

Editorial Paediatrics and Child Health May/June 2001, Volume 6, Number 5 Flesh-eating disease: A note on necrotizing fasciitis H Dele Davies MD MSc, Child Health Research Unit, Alberta Children’s Hospital and Departments of Pediatrics, Microbiology and Infectious Diseases and Community Health Sciences, University of Calgary, Calgary, Alberta There has been much media attention in the past few years to the condition dubbed ‘flesh-eating disease’, which refers, primarily, to a form of invasive group A beta hemolytic streptococcal (GABHS) infection that leads to fascia and muscle necrosis. In 1999, the Canadian Paediatric Society issued a statement on the state of knowledge and management of children, and close contacts of persons with all-invasive GABHS disease (1). The present note is intended to deal specifically with necrotizing fasciitis (NF) by providing an update on the limited current state of knowledge, diagnosis and management. Surveillance to establish actual national rates and epidemiology of NF through the Canadian Paediatric Society is proposed.

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Flesh-eating Disease A Note On Necrotizing Fasciitis

Flesh-eating disease: A note on necrotizing fasciitis H Dele Davies MD MSc, Child Health Research Unit, Alberta Children’s Hospital and Departments of Pediatrics, Microbiology and Infectious Diseases and Community Health Sciences, University of Calgary, Calgary, Alberta Paediatrics and Child Health May/June 2001, Volume 6, Number 5 There has been much media attention in the past few years to the condition dubbed ‘flesh-eating disease’, which refers, primarily, to a form of invasive group A beta hemolytic streptococcal (GABHS) infection that leads to fascia and muscle necrosis. In 1999, the Canadian Paediatric Society issued a statement on the state of knowledge and management of children, and close contacts of persons with all-invasive GABHS disease (1). The present note is intended to deal specifically with necrotizing fasciitis (NF) by providing an update on the limited current state of knowledge, diagnosis and management. Surveillance to establish actual national rates and epidemiology of NF through the Canadian Paediatric Society is proposed

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Necrotising Fasciitis

BMJ 2005;330:830-833 (9 April), doi:10.1136/bmj.330.7495.830 Clinical review Necrotising fasciitis Saiidy Hasham, research registrar in plastic surgery1, Paolo Matteucci, specialist registrar in plastic surgery1, Paul R W Stanley, consultant plastic surgeon1, Nick B Hart, consultant plastic surgeon1 1 Department of Plastic Reconstructive and Hand Surgery, Castle Hill Hospital, Cottingham, East Yorkshire HU16 5JQ Correspondence to: S Hasham saiidyhasham@hotmail.com Necrotising fasciitis is a rare but life threatening condition that requires immediate action, but uncertainties still hamper prompt diagnosis and treatment

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Necrotizing Fasciitis

Necrotizing Fasciitis from Wounds Posted 11/25/2002 Jennifer T. Trent, MD, Robert S. Kirsner, MD Abstract Necrotizing fasciitis (NF) is a rare, life-threatening infection resulting in necrosis of the skin, subcutaneous tissue, and fascia. Mortality rates have been noted as high as 73 percent. Certain conditions can predispose patients to NF, such as diabetes mellitus, immunosuppressive medications, and AIDS. Patients usually complain of excessive pain as well as constitutional symptoms. Cutaneous findings include diffuse redness and edema progressing to necrosis and hemorrhagic bullae. Because of this rapid progression, it is important to diagnose and treat NF quickly to decrease mortality. Treatment includes broad-spectrum antibiotic coverage, nutritional supplements, hemodynamic support, wound care, and prompt surgical debridement.

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Necrotizing Fasciitis

E-Medicine 2005 Necrotizing Fasciitis Author: Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School Coauthor(s): Rajendra Kapila, MD, Associate Professor, Department of Medicine, UMDNJ, New Jersey Medical School Necrotizing fasciitis (NF) is an insidiously advancing soft tissue infection characterized by widespread fascial necrosis. A number of bacteria in isolation or as a polymicrobial infection can cause NF. The organisms most closely linked to NF are group A beta-hemolytic streptococci, though these bacteria may cause only a minority of the cases. Most cases are caused by other bacteria or different streptococcal serotypes. NF was first described in 1848. In 1920, Meleney identified 20 patients in China in whom hemolytic streptococcus was the sole organism. Wilson coined the term necrotizing fasciitis in 1952 and found no specific pathologic bacteria related to the disease. A few distinct NF syndromes should be recognized. The 3 most important are type I, or polymicrobial; type II, or group A streptococcal; and type III gas gangrene, or clostridial myonecrosis. A variant of NF type I is saltwater NF, in which an apparently minor skin wound is contaminated with saltwater containing a Vibrio species. NF may occur as a complication of a variety of surgical procedures, including cardiac catheterization (Federman, 2004). Familiarity with NF may facilitate earlier diagnosis and initiation of appropriate therapy.

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Necrotizing Fasciitis

Surgery in Africa Article Necrotizing Fasciitis While cellulitis and pyomyositis can be treated with reasonable success and low mortality rates, this is not the case for necrotizing soft tissue infections (NSTI). Here mortality rates range from 30-70% and have not decreased significantly despite modern therapy. (40) Reports from Singapore (41), India (42) and Oman (43) give a sense of the non-Western experience. NSTIs can be divided into two major categories: 1. Necrotizing fasciitis (NF) and 2. Gas gangrene. (44) Necrotizing fasciitis is further divided on the basis of clinical picture and microbiology into types I and II. (more)

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Necrotizing Fasciitis

Necrotizing Fasciitis from Wounds Posted 11/25/2002 Jennifer T. Trent, MD, Robert S. Kirsner, MD Abstract Necrotizing fasciitis (NF) is a rare, life-threatening infection resulting in necrosis of the skin, subcutaneous tissue, and fascia. Mortality rates have been noted as high as 73 percent. Certain conditions can predispose patients to NF, such as diabetes mellitus, immunosuppressive medications, and AIDS. Patients usually complain of excessive pain as well as constitutional symptoms. Cutaneous findings include diffuse redness and edema progressing to necrosis and hemorrhagic bullae. Because of this rapid progression, it is important to diagnose and treat NF quickly to decrease mortality. Treatment includes broad-spectrum antibiotic coverage, nutritional supplements, hemodynamic support, wound care, and prompt surgical debridement.

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Necrotizing Fasciitis

Definition Necrotizing fasciitis is a rare, often fulminant, rapidly progressive infectious process primarily involving the fascia and subcutaneous tissue. The pathophysiology involves the rapid spread of infection along the fascial planes, fascial necrosis and thrombosis of the subcutaneous blood vessels, leading to cutaneous gangrene. Approximately 500 to 1500 cases reported annually in the US. The most often associated comorbities are diabetes mellitus and peripheral vascular disease. It is most often peripheral, involving the lower limb. Delay to diagnosis is one of the most prominent predictors of mortality (along with diabetes). Prognosis for necrotizing fasciitis depends heavily on early recongnition and determination of the extent of necrosis in the preoperative planning. Clinical studies are lacking that compare different imaging modalities to the gold standard of fasciotomy. These series are typically small and only look at a handful of cases. Diagnostic Radiology/Musculoskeletal Imaging/Infection/Necrotizing fasciitis From Wikibooks, the open-content textbooks collection

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Necrotizing Fasciitis eMedicine Emergency

E-Medicine 2005 Necrotizing Fasciitis Michael Maynor, MD, Clinical Assistant Professor, Department of Hyperbaric/Emergency Medicine, Louisiana State University School of Medicine For more than a century, many authors have described soft tissue infections. Their occurrence has been on the rise because of an increase in immunocompromised patients with diabetes mellitus, cancer, alcoholism, vascular insufficiencies, organ transplants, HIV, or neutropenia. Necrotizing fasciitis can occur after trauma or around foreign bodies in surgical wounds, or it can be idiopathic, as in scrotal or penile necrotizing fasciitis. Necrotizing fasciitis has also been referred to as hemolytic streptococcal gangrene, Meleney ulcer, acute dermal gangrene, hospital gangrene, suppurative fascitis, and synergistic necrotizing cellulitis. Fournier gangrene is a form of necrotizing fasciitis that is localized to the scrotum and perineal area. Necrotizing fasciitis is a progressive, rapidly spreading, inflammatory infection located in the deep fascia, with secondary necrosis of the subcutaneous tissues. Because of the presence of gas-forming organisms, subcutaneous air is classically described in necrotizing fasciitis. This may be seen only on radiographs or not at all. The speed of spread is directly proportional to the thickness of the subcutaneous layer. Necrotizing fasciitis moves along the deep fascial plane. These infections can be difficult to recognize in their early stages, but they rapidly progress. They require aggressive treatment to combat the associated high morbidity and mortality. The causative bacteria may be aerobic, anaerobic, or mixed flora, and the expected clinical course varies from patient to patient.

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Necrotizing Fasciitis From Apophysomyces Elegans Infection Following Trauma

Necrotizing Fasciitis From Apophysomyces elegans Infection Following Trauma from Infections in Medicine Posted 08/08/2002 Lorraine M. Dowdy, DO, Jose G. Castro, MD, Carlos Duchesne, MD, Timothy Cleary, MD Abstract Following a motorcycle accident, a 29-year-old man had fixation of a femoral fracture with an intramedullary rod. After he was discharged, the wound deteriorated rapidly and did not improve despite multiple debridements and antibiotic therapy. Apophysomyces elegans grew on cultures, and treatment with amphotericin B was followed by healing and plastic reconstruction.

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Necrotizing fasciitis mimicking a ruptured popliteal cyst

An acutely swollen calf is a common clinical problem. Causes include deep venous thrombosis (DVT), ruptured popliteal cyst, haematoma and infection. We describe a case of necrotizing fasciitis diagnosed clinically as a DVT and by ultrasonography as a ruptured cyst.
Necrotizing fasciitis mimicking a ruptured popliteal cyst. Watts RA, Bretland PM. J R Soc Med. 1990 Jan;83(1):52-3.

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