Fasciitis necrotisans – duplicitas casuum


Authors: L. Klein 1,2;  R. Fabian 3;  P. Šafránek 4;  P. Paterová 5;  I. Slaninka 1;  E. Havel 4;  P. Dostál 6;  M. Serbák 7
Authors‘ workplace: Oddělení plastické chirurgie a léčby popálenin chirurgické kliniky Lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Hradec Králové 1;  Katedra vojenské chirurgie, Fakulta vojenského zdravotnictví Univerzity obrany, Hradec Králové 2;  Anesteziologicko-resuscitační oddělení Nemocnice Na Homolce, Praha 3;  Jednotka intenzivní péče chirurgické kliniky Lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Hradec Králové 4;  Ústav klinické mikrobiologie Lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Hradec Králové 5;  Klinika anesteziologie, resuscitace a intenzivní medicíny Lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Hradec Králové 6;  Chirurgické oddělení, Litomyšlská nemocnice, Litomyšl 7
Published in: Rozhl. Chir., 2018, roč. 97, č. 9, s. 432-441.
Category: Case Report

Overview

Necrotizing fasciitis is a dangerous bacterial infectious disease that is not commonplace in Czech society. On the other hand, neither is it so rare that the majority of surgeons should not come across it occasionally. In the early stages, pathological changes in fascia, subcutaneous tissue and even skin may run an inconspicuous course. However, this can rapidly deteriorate into shock and sepsis which may lead to multi-organ failure and an imminent life-threatening condition. The fatality rate of necrotizing fasciitis among high-risk groups (e.g. diabetics, patients who are immuno-compromised, obese and/or elderly, malnourished, or with a history of drug use), is particularly steep, reaching as high as 73%. Treatment for this condition consists of early, radical surgical intervention in conjunction with targeted antibiotherapy. Complex resuscitative and intensive care, including rehabilitation, are standard components of post-surgical management. Use of hyperbaric oxygen therapy, if such an opportunity exists, is also recommended. Interdisciplinary collaboration is a vital prerequisite for successful treatment. This article describes two case-studies of necrotizing fasciitis that occurred in men of similar age during a three-year period. Both patients presented with very similar and complicated disease courses, and both were successfully treated by the same interdisciplinary team comprised of clinicians from various specialized departments.

Key words:

necrotizing fasciitis − radical necrectomy – antibiotherapy − hyperbaric oxygen therapy − complex resuscitative and intensive care


Sources
  1. Jandík J, Vokůrka J. Nekrotizující fasciitida břišní stěny po cholecystektomii – kazuistika. Rozhl Chir 2009;88:35−9.

  2. Shang S, Zhang R, Hou Z. Necrotizing fasciitis – A catastrophic complication following routine tibia fracture surgery. Medicine 2017. Available from: http://dx.doi.org/10.1097/MD.0000000000006908.

  3. Kerbaj J, Aubry C, Prost C, et al. Thigh abscess and necrotizing fasciitis following an inside-out transobturator tape intervention: a case report. J of Med Case Reports 2016. Available from: DOI 10.1186/s13256-016-0942-3.

  4. Svatoň R, Neumann C, Hanslianová M. Nekrotizující fasciitida, vzácná komplikace laparoskopické apendektomie. Rozhl Chir 2009;88:27−31.

  5. Makadia J, Bhanot N, Mancini SA, et al. Clinical evolution, management, and resolution of type II necrotizing fasciitis. Intern Emerg Med 2015;10:389−1.

  6. Gawaziuk JP, Liu T, Sigurdson L, et al. Free tissue transfer for necrotizing fasciitis reconstruction: A case series. Burns 2017. Available from: http://dx.doi.org/10.1016/j.burns.2017.04.007.

  7. Lee ChY, Li YY, Huang TW, et al. Synchronous multifocal necrotizing fasciitis prognostic factors: a retrospective case series study in a single center. Infection 2016;44:757−63.

  8. Stead TS, Hedna VS. Necrotizing fasciitis presenting as an itchy thigh. Case reports in emergency medicine 2016. Available from: http://dx.doi.org/10.1155/2016/6376301.

  9. Kojič M, Mikič D, Nožič D, et al. Streptococcal necrotizing fasciitis with toxic shock syndrome and rapid fatal outcome. Srp Arh Celok Lek 2015;143:476−9.

  10. Gürlich R, Adámková V, Ulrych J, et al. Infekce kůže a měkkých tkání. Rozhl Chir 2016;95:141−6.

  11. Hassan Z, Mullins RF, Friedman BC, et al. Treating necrotizing fasciitis with or without hyperbaric oxygen therapy. Undersea Hyperb Med 2010;37:115−23.

  12. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis 2014;59:147−59.

  13. Hakkarainen TW, Kopari NM, Pham TN, et al. Necrotizing soft tissue infections: review and current concepts in treatment, systems of care, and outcomes. Curr Probl Surg 2014;51:344−62.

  14. Versalovic J. Manual of clinical microbiology. Washington, ASM Press 2011:834−58.

  15. Brook I, Frazier EH. Clinical and microbiological features of necrotizing fasciitis. Journal of Clinical Microbiology 1995;33:2385−7.

  16. Montravers P, Snauwaert A, Welsch C. Current guidelines and recommendations for the management of skin and soft tissue infection 2016. Curr Opin Infect Dis 2016;29:131−8.

  17. Adámková V. Antibiotická léčba infekcí kůže a měkkých tkání – současné možnosti a limity. Remedia 2015;2:150−3.

  18. Tsitsilonis S, Druschel C. Necrotizing fasciitis: is the bacterial spectrum changing? Langenbeck Arch Surg 2013;398:153−9.

  19. Misiakos EP, Bagias G, Patapis P, et al. Current concepts in the management of necrotizing fasciitis. Frontiers in Surgery 2014;1:36.

  20. Bhatia, N, Castro-Borobio M, Greene J, et al. Necrotizing fasciitis secondary to eromonas Infection presenting with septic shock. Case Reports in Emergency Medicine 2017. Available from: htpps://doi.org/10.1155/2017/4607582.

  21. Graves C, Saffle J, Morris S, et al. Caloric requirements in patients with necrotizing fasciitis. Burns 2005;31:55−9.

  22. Light TD, Choi KC, Thomsen TA. Long-term outcomes of patients with necrotizing fasciitis. J Burn Care Res 2010;31:93−9.

  23. Friedrich O, Reid MB, Van den Berghe G, et al. The sick and the weak: Neuropathies/myopathies in the critically Ill. Physiological Reviews 2015;95:1025−1109.

  24. Königová R, Bláha J a kol. Komplexní léčba popáleninového traumatu. Univerzita Karlova v Praze, Praha, Nakladatelství Karolinum 2010.

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Surgery Orthopaedics Trauma surgery
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