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Necrotizing soft tissue infections

Alisson R Teles, Spencer Montgomery, Kenneth C Thomas
BACKGROUND: Necrotizing fasciitis (NF) is a surgical diagnosis characterized by a rapidly progressive soft tissue infection, widespread tissue necrosis, and associated systemic illness. Friability of the superficial fascia, dishwater-gray exudate, and absence of pus are surgical characteristics of this diagnosis. Due to the rapid progression of the infection, early recognition and aggressive surgical debridement are crucial to reduce mortality. Despite being commonly seen by general, plastic, and orthopedic surgeons, NF is an extremely rare spine surgery emergency...
October 12, 2018: World Neurosurgery
Travis L Perry, Lindsay M Kranker, Erin E Mobley, Eileen E Curry, R Michael Johnson
INTRODUCTION: Fournier's gangrene (FG) remains a forbidding necrotizing soft tissue infection (NSTI) that necessitates early recognition, prompt surgical excision, and goal-directed antibiotic therapy. Traditionally, surgical management has included wide radical excision for sepsis control, but this management often leaves large, morbid wounds that require complex wound coverage, prolonged hospitalizations, and/or delayed healing. OBJECTIVE: The purpose of this case series is to report the outcomes of FG using a surrogate approach of concurrent debridement of spared skin and soft tissue, negative pressure wound therapy (NPWT), and serial delayed primary closure (DPC)...
October 2018: Wounds: a Compendium of Clinical Research and Practice
Amelia Breyre, Bradley W Frazee
This article covers the diagnosis and treatment of skin and soft tissue infections commonly encountered in the emergency department: impetigo, cutaneous abscesses, purulent cellulitis, nonpurulent cellulitis, and necrotizing skin and soft tissue infections. Most purulent infections in the United States are caused by methicillin-resistant Staphylococcus aureus. For abscesses, we emphasize the importance of incision and drainage. Nonpurulent infections are usually caused by streptococcal species and initial empiric antibiotics need not cover methicillin-resistant Staphylococcus aureus...
November 2018: Emergency Medicine Clinics of North America
Seung-Han Shin, Il-Kyu Park, Jin-Woo Kang, Yong-Suk Lee, Yang-Guk Chung
BACKGROUND: Purulent musculoskeletal infections often require surgical debridement and drainage. However, when the infection is extensive or involving multiple layers of tissues, maintaining drainage of the involved spaces can be difficult, even with the application of vacuum-assisted closure (VAC) therapy. Wide exposure and aggressive debridement is often required for such cases, which in turn may complicate wound coverage. METHODS: A retrospective review was performed for 16 patients with musculoskeletal infections treated surgically...
September 2018: Journal of Hand Surgery Asian-Pacific Volume
Matthias Zirk, Charlotte Wenzel, Johannes Buller, Joachim E Zöller, Max Zinser, Franziska Peters
OBJECTIVES: A central role of infections in the treatment of MRONJ patients is widely accepted. An investigation of the MRONJ lesions' biofilms as potential pathogens seems logical. MATERIALS AND METHODS: We investigated the clinical data of our MRONJ patients who received surgery in advanced stage of the disease. Special attention was granted to the local colonizers harvested from osseous MRONJ specimens and submucosal putrid infections. RESULTS: Eleven out of 71 patients presented a spontaneous onset of the disease and for 60 out of 71 patients a trigger was detected...
October 1, 2018: Clinical Oral Investigations
Marco Sciarra, Andrea Schimmenti, Tommaso Manciulli, Cristina Sarda, Marco Mussa, Laura Sacco, Bianca Mariani, Angela Maria Di Matteo, Paolo Orsolini
Necrotizing fasciitis (NF) is a soft tissue infection affecting subcutaneous tissue and the muscular fascia without involvement of the muscle and can be either monomicrobial or polymicrobial. Monomicrobial infections are usually caused by group A streptococci, while infections caused by anaerobic germs usually affect immunodepressed patients. We report a rare case of NF caused by two anaerobic bacteria in an immunocompetent patient.
2018: Case Reports in Infectious Diseases
Annie Laurie Benzie, Jason Clark, Jason Farrah, Alejandro Garcia, Joshua Hagan, Winston Richards, Darwin Ang
No abstract text is available yet for this article.
September 1, 2018: American Surgeon
Annie Laurie Benzie, Jason Clark, Jason Farrah, Alejandro Garcia, Joshua Hagan, Winston Richards, Darwin Ang
No abstract text is available yet for this article.
September 1, 2018: American Surgeon
Shu-Jun Chen, Yu-Xuan Chen, Jian-Rui Xiao, Xiao-Zong Wei, Shuang-Min Chen, Wang-Zhan Jiang
PURPOSE: Necrotizing fasciitis is a severe soft tissue infection that is uncommon in the head and neck region. Despite the advancement of care over the past few decades, the mortality rate remains high. Negative pressure wound therapy (NPWT), an advanced wound-healing technique, has become increasingly popular for a wide variety of complicated wounds. Since December 2015, we have used this technique in the management of necrotizing fasciitis of the head and neck. We report a consecutive case series treated with NPWT as the initial surgical procedure...
August 28, 2018: Journal of Oral and Maxillofacial Surgery
Nicole M Garcia, Jenny Cai
Necrotizing soft tissue infections (NSTI) are characterized by rapidly progressive infection that causes tissue necrosis with associated sepsis and multisystem organ failure. A rapid diagnosis is essential to decreasing the morbidity and mortality of NSTIs. There must be a high index of suspicion based on history and physical examination. There are no adjunct laboratory values or imaging that have high sensitivity and specificity in the diagnosis of NSTI. The treatment involves emergent, radical surgical debridement of involved tissues and broad spectrum antibiotics...
October 2018: Surgical Clinics of North America
Anuradha Vajjala, Debabrata Biswas, Wei Hong Tay, Emanuel Hanski, Kimberly A Kline
Group A Streptococcus (GAS) is a human pathogen that causes infections ranging from mild to fulminant and life-threatening. Biofilms have been implicated in acute GAS soft-tissue infections such as necrotising fasciitis (NF). However, most in vitro models used to study GAS biofilms have been designed to mimic chronic infections and insufficiently recapitulate in vivo conditions along with the host-pathogen interactions that might influence biofilm formation. Here, we establish and characterise an in vitro model of GAS biofilm development on mammalian cells that simulates microcolony formation observed in a mouse model of human NF...
September 21, 2018: Cellular Microbiology
Bi O Jeong, Duke Whan Chung, Jong Hun Baek
RATIONALE: Calcific myonecrosis is a very rare late sequela that occurs in patients who have had trauma accompanied by vascular compromise, in which a single muscle or entire muscles in a compartment undergoes necrosis and form a calcified mass. It is mostly a benign entity, but some cases cause bone destruction and form non-healing chronic sinuses. In such cases, wound management becomes difficult and there is a potential risk of secondary infection. PATIENT CONCERNS: A 60-year-old male was referred for evaluation of a pain, erythematous changes, and draining sinus of the anterolateral aspect of his left leg...
September 2018: Medicine (Baltimore)
Wael Majdoub, Amal Mosbahi, Frederic Bonbled
Fournier gangrene is a rare fulminant necrotizing infection of the skin and soft tissue of the perineum that may result in rapid death. We describe the autopsy case of a 70-year-old female with uncontrolled diabetes mellitus who was found unexpectedly dead in her house where she lived with her dog. Examination of the body revelaed a deep necrotic ulceration of the perineum with exposure of the underlying deep muscles that was initially misinterpreted by police officers as post mortem animal predation. Medicolegal examination and histological and microbiological analyses eliminated this hypothesis and the diagnosis of septic multiorgan failure due to necrotizing fasciitis was retained as a cause of death...
September 19, 2018: Forensic Science, Medicine, and Pathology
M Severyns, R Nevière, D Resiere, T Andriamananaivo, L Decaestecker, H Mehdaoui, G A Odri, J L Rouvillain
Bothrops lanceolatus is an endemic Crotalidae species in Martinique, where approximately 30 cases of envenoming are managed yearly. Envenoming characteristics from Bothrops species include local tissue damage, systemic bleeding, and hemodynamic alterations. We hereby report a case of severe envenomation following B. lanceolatus snakebite to the right calf. Severe local manifestations developed progressively up to the lower limb despite adequate antivenom therapy. Systemic manifestations of venom also occurred, resulting in intensive care therapy...
September 17, 2018: American Journal of Tropical Medicine and Hygiene
Suba Nookala, Santhosh Mukundan, Alexander Fife, Jeyashree Alagarsamy, Malak Kotb
Invasive Group A Streptococcus (GAS) infections include necrotizing soft tissue infections (NSTI) and streptococcal toxic shock syndrome (STSS). We have previously shown that host HLA class-II allelic variations determine the risk for necrotizing fasciitis (NF), a dominant subgroup of NSTI, and STSS by modulating responses to GAS superantigens (SAgs). SAgs are pivotal mediators of uncontrolled T-cell activation, triggering a pro-inflammatory cytokine storm in the host. FoxP3-expressing CD4+ CD25+ T-regulatory cells (Tregs) comprise phenotypically and functionally heterogeneous subsets with a profound ability to suppress inflammatory responses...
September 17, 2018: Infection and Immunity
Hannah Zhao-Fleming, Audrey Hand, Kelly Zhang, Robert Polak, Armand Northcut, Daron Jacob, Sharmila Dissanaike, Kendra P Rumbaugh
The USA is currently going through an opioid crisis, associated with tremendous economic and societal impacts. In response to this crisis, healthcare professionals are looking for alternative pain management methods, and non-steroidal anti-inflammatory drugs (NSAIDs) are a sensible choice because of their effectiveness after surgical procedures. However, before surgeons start prescribing NSAIDs in place of opioids, it is crucial to first understand their potential post-surgical complications. The goal of this review is to summarize the data obtained through both animal and human studies, which suggest how a dramatic increase in NSAID use may affect these post-surgical complications...
2018: Burns and Trauma
Tina Steiner, Annett Seiffart, Julia Schumann, Michael Bucher
Necrotizing soft tissue infection is a severe life-threatening disease correlated with high mortality. Until now, therapeutic concepts include antimicrobial, intensive care and surgical interventions, as well as the application of hyperbaric oxygenation (HBO), which still has a controversial status. Evidence of the therapeutic concept of HBO is, so far, limited to positive experiences in case studies and physiological benefits in animal studies. That is why the HBO therapy method is not yet fully established...
2018: Advances in Experimental Medicine and Biology
Domenico Ricucci, José F Siqueira, Simona Loghin, Antonio Grosso, Erica M Valois, Alex S M Leal
This article describes 2 unusual cases of mucosal fenestration associated with necrotic infected teeth, resulting in exposure of the root apex to the oral cavity. Both cases consisted of maxillary incisors with pulp necrosis and radiographic/tomographic evidence of apical periodontitis. Clinically, the root apex was exposed to the oral cavity through a fenestration in both bone and mucosa and covered with bacterial plaque and calculus. These teeth were treated by a combination of nonsurgical and surgical endodontic treatment...
October 2018: Journal of Endodontics
Obada Hasan, Wajiha Khan, Muneeba Jessar, Aly Zaheer Pathan, Riaz Hussain Lakdawala
INTRODUCTION: Aeromonas are Gram-negative bacilli often causing necrotizing fasciitis or sepsis in immunocompromised patients. Aeromonas Hydrophila is most often found in immunocompromised patients or those with burns or aquatic trauma. When patients present with a discharge and infection on bone graft donor site and progressive sepsis, an Aeromonas hydrophila infection should be considered in the differential diagnosis. PRESENTATION OF CASE: We report here a rare case of Aeromonas hydrophila with surgical site sepsis/infection in an immunocompromised 69 years old female, with several comorbids...
August 25, 2018: International Journal of Surgery Case Reports
Young-Keun Lee, Malrey Lee
INTRODUCTION: Infected segmental loss of the Achilles tendon with overlying soft tissue and skin defect remains a more complex reconstructive challenge. Here, we present a functional reconstruction of infected Achilles tendinitis with combined soft tissue defects using a free composite anterolateral thigh (ALT) flap with vascularized fascia lata in an elderly patient. CASE PRESENTATION: A 71-year-old male patient was transferred to our department due to soft tissue defect of the left lower leg and infected Achilles tendinitis...
August 2018: Medicine (Baltimore)
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