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Necrotizing soft tissue infections

Ann-Mari Fagerdahl, Vibeke E Knudsen, Ingrid Egerod, Annette E Andersson
INTRODUCTION: Necrotizing soft tissue infection (NSTI) is a severe, life-threatening condition requiring immediate diagnosis and treatment to avoid widespread tissue destruction and death. Current research seeks to explain the complex interaction between patient and disease agent, whereas only few studies have addressed the patient perspective. OBJECTIVE: The present study aimed to describe the patient experience of NSTI in the first six months after diagnosis. METHODS: The study had a qualitative design with patient involvement...
March 12, 2019: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Milo Gatti, Laura Elisa Gasparini, Matteo Laratta, Anna Sigurtà, Anna Rossi, Paolo Brioschi, Osvaldo Chiara, Chiara Vismara, Francesco Scaglione, Sergio Arlati
To illustrate the effectiveness of our intensive multidisciplinary management (IMM) in the treatment of severely ill patients with necrotizing soft tissue infections (NSTIs). A retrospective observational study was conducted in a general ICU. Thirty-two consecutive patients undergoing IMM were carefully compared with 30 consecutive patients receiving a standard management (SM). IMM combined intensive care management, early surgical debridement followed by daily inspection of surgical wounds, close microbiological surveillance, and targeted high-dose antibiotics...
March 6, 2019: European Journal of Clinical Microbiology & Infectious Diseases
Wei-Bin Du, Li-Xiang Wang, Feng Shen, Lin-Ru Zeng, Dang Wu, Guo-Ming Wu, Liang Xu
OBJECTIVE: To explore surgical methods and clinical effects of three different types of mini skin flap transplantation for repairing finger soft tissue with bone defect. METHODS: Thirty-three patients with finger soft tissue or bone defect were treated from December 2014 to October 2016, including 24 males and 9 females aged from 21 to 52 years old with an average of (36.42±5.70) years old, and soft tissue defect area ranged from 1.3 cm×1.8 cm to 2.3 cm×4.2 cm...
January 25, 2019: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Grazia Maria Cozzupoli, Daniele Gui, Valerio Cozza, Claudio Lodoli, Mariano Alberto Pennisi, Aldo Caporossi, Benedetto Falsini
Necrotizing fasciitis (NF) is a rare infection that spreads rapidly along the subcutaneous soft tissue planes. NF rarely involves the periorbital region due to the excellent blood supply of this region. We report a case of periorbital necrotising fasciitis following herpes zoster (HZ) in an immunocompromised 70-year-old patient with a dramatically rapid evolution into septic shock. In our patient, the surprisingly rapid spread of the bacterial superinfection led the periorbital cellulitis to turn into frank NF within 2 hours, with an overwhelming evolution...
2019: Case Reports in Ophthalmological Medicine
C Fernando de Almeida Barros Mourão, M D Calasans-Maia, M Del Fabbro, F Le Drapper Vieira, R Coutinho de Mello Machado, R Capella, R J Miron, G Gomes Alves
Medication related osteonecrosis of the jaw (MRONJ) is characterized by exposed necrotic bone in the maxillofacial region that persists for more than eight weeks in patients taking antiresorptive or antiangiogenic drugs for bone metastasis or osteoporosis. The management of such condition depends on several factors, among which the staging of MRONJ. Though, a specific gold standard treatment has not been established to date. The aim of this case series is to describe the outcome of surgical treatment of MRONJ with the adjunct of Platelet-rich Fibrin (PRF)...
February 20, 2019: Journal of Stomatology, Oral and Maxillofacial Surgery
Daniel Tena, Luciano Saa
We describe the characteristics of 11 cases of skin and soft tissue infections due to Cutibacterium (formerly Propionibacterium) avidum. This microorganism should be considered a potential skin pathogen especially in patients with breast infections. The clinical outcome is usually good but serious infections such as necrotizing infections may occur.
February 19, 2019: Anaerobe
Kunal Panwar, Therese M Duane, Jeffrey M Tessier, Khushbu Patel, James M Sanders
BACKGROUND: Necrotizing soft-tissue infections are a devastating infection that is rarely caused by Actinomyces spp. CASE REPORT: A 45-year-old obese previously healthy male presented to the emergency department with diabetic ketoacidosis. The patient developed systemic signs of infections and right medial thigh pain subsequently diagnosed as a necrotizing soft-tissue infection. Successful treatment included prompt surgical intervention and initiation of broad-spectrum antimicrobial drugs...
February 21, 2019: Surgical Infections
Robert A Tessler, Steve Vanhoy, Katherine Bergus, Christine Fong, Eileen M Bulger, Frederick P Rivara, Monica S Vavilala
BACKGROUND: The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score may distinguish necrotizing soft tissue infection (NSTI) from non-NSTI. The association of higher preoperative LRINEC scores with escalations of intraoperative anesthesia care in NSTI is unknown and may be useful in communicating illness severity during patient handoffs. MATERIALS AND METHODS: We conducted a retrospective cohort study of first operative debridement for suspected NSTI in a single referral center from 2013 to 2016...
February 12, 2019: Journal of Surgical Research
Margaret H Lauerman, Thomas M Scalea, W Andrew Eglseder, Raymond Pensy, Deborah M Stein, Sharon Henry
Little data exist about management of wounds created by debridement in necrotizing soft tissue infections (NSTIs). Multiple wound coverage techniques exist, including complete primary wound closure, split-thickness skin grafting, secondary intention, and flap creation. We hypothesized that all wound coverage techniques would be associated with high rates of successful wound coverage and low crossover rates to other wound coverage techniques. NSTIs over a three-year period were retrospectively reviewed. Both the initial and secondary wound coverage techniques (if necessary) were recorded...
November 1, 2018: American Surgeon
Tom J Liu, Hao-Chih Tai, Kuo-Liong Chien, Nai-Chen Cheng
BACKGROUND: Necrotizing fasciitis (NF) is a life-threatening soft tissue infection with low incidence that requires prompt surgery. In the initial stage, it is difficult to distinguish NF and cellulitis, and limited population-based reports are available. METHODS: We queried inpatient data sets of National Health Institute Research Database in Taiwan from 2002 to 2011 for all patients with diagnoses of NF. Of them, only patients who underwent surgeries and had been admitted to intensive care units were included as the study group...
February 6, 2019: Journal of the Formosan Medical Association, Taiwan Yi Zhi
Lauren C Beauchamp, Lisa G Mostafavifar, David C Evans, Anthony T Gerlach
BACKGROUND: Necrotizing soft-tissue infection (NSTI) is a devastating disease associated with high rates of morbidity and mortality. Hyperglycemia is associated with poor wound healing; however, there are no studies evaluating glycemic control outcomes in patients with NSTI. The objective of this study was to examine disease progression and death in patients with NSTI who achieved early glycemic control (EGC) compared with patients that did not. METHODS: A retrospective chart review of patients with NSTI was conducted between November 2011 and August 2017...
February 4, 2019: Surgical Infections
J A Keeley, A Kaji, D Y Kim, B Putnam, A Neville
PURPOSE: Diagnosing intestinal strangulation in the setting of incarcerated hernias remains challenging. Hyponatremia has been identified as a predictor of necrotizing soft tissue infections and gangrenous cholecystitis. We hypothesized that hyponatremia could predict bowel ischemia in patients with incarcerated hernias. METHODS: Medical records for 163 patients with incarcerated hernias over a 5-year period were reviewed. Preoperative clinical, laboratory, and radiologic findings and final intraoperative diagnosis were collected...
January 28, 2019: Hernia: the Journal of Hernias and Abdominal Wall Surgery
D Yao, D F Hao, F Zhao, X F Hao, G Feng, W L Chu, Z Q Chen
Objective: To investigate the effects of platelet-rich plasma (PRP) combined with polylactic acid/polycaprolactone (PLA/PCL) on healing of mininature pig deep soft tissue defect caused by fragment injury. Methods: Two male Bama miniature pigs with 11 to 12 months (the same below) were selected by lottery to prepare PRP. The other twenty-seven male Bama miniature pigs were used to reproduce deep soft tissue defect caused by high-explosive ammunition fragment injury on bilateral posterior femoral region. According to the random number table, 27 pigs were divided into control group, material group, and PRP+material group, with 9 pigs in each group...
January 20, 2019: Zhonghua Shao Shang za Zhi, Zhonghua Shaoshang Zazhi, Chinese Journal of Burns
G Siebenbürger, B Grabein, T Schenck, C Kammerlander, W Böcker, C Zeckey
BACKGROUND: Multi-drug-resistant bacteria (e.g. Carbapenem-resistant Acinetobacter baumannii, extended-spectrum betalactamase or carbapenemase-producing enterobacteriaceae) are emerging in early-onset infections. So far, there is no report describing the eradication of these bacteria in a osseous infection of an open proximal tibial fracture in combination with the hexapod technology to address both osseous consolidation and closed drop foot correction. CASE PRESENTATION: After sustaining a proximal tibial fracture (Gustilo 3B), a 41-year-old man was primarily treated with open reduction and internal fixation by a locking plate and split-thickness skin graft in the home country...
January 19, 2019: European Journal of Medical Research
Ahmed M Hashem, Risal Djohan, Steven Bernard, Mark Hendrickson, Graham Schwarz, Bahar B Gharb, Antonio Rampazzo, Gary S Hoffman, Gaby Doumit, Wilma Bergfeld, James E Zins, Maria Siemionow, Francis Papay, Brian Gastman
BACKGROUND: We report new data for a rare face transplant performed 3 years ago. Granulomatosis with polyangiitis (GPA) (Wegener) is a severe autoimmune necrotizing vasculitis and parenchymal inflammatory disease that can affect any organ including those of the craniofacial region. Skin involvement manifests as malignant pyoderma. This account (1) highlights the technical details of face transplantation for this unique indication, (2) reports the 3-year posttransplant outcome, and (3) describes relevant immunological aspects...
January 9, 2019: Annals of Plastic Surgery
Kyle D Buchan, Simon J Foster, Stephen A Renshaw
Staphylococcus aureus has colonized humans for at least 10 000 years, and today inhabits roughly a third of the population. In addition, S. aureus is a major pathogen that is responsible for a significant disease burden, ranging in severity from mild skin and soft-tissue infections to life-threatening endocarditis and necrotizing pneumonia, with treatment often hampered by resistance to commonly available antibiotics. Underpinning its versatility as a pathogen is its ability to evade the innate immune system...
January 9, 2019: Microbiology
Stormy Lemay, Elizabeth McElroy, Kersten Reider
Necrotizing soft tissue infection is a rapidly spreading bacterial infection that can quickly destroy a person's muscles, skin, and underlying tissue. In this retrospect chart review, we will look at how the utilization of negative pressure wound therapy with instillation and dwell (NPWTi-d) and novel reticulated open cell foam (ROCF-CC) assisted with the healing of a patient's wound along with decreasing the time spent in the operating room. NPWTi-d provided the benefits of wound healing such as solubilizing the infectious material and removing the devitalized tissue...
October 26, 2018: Curēus
John P Livingstone, Ian G Hasegawa, Patrick Murray
Necrotizing fasciitis is a rapidly spreading infection of the soft tissue, which carries significant morbidity and mortality. This condition is treated with broad-spectrum antibiotics, irrigation and surgical debridement of the affected area, and hemodynamic support. Negative pressure wound therapy (NPWT) has been utilized after surgical debridement to promote wound healing, especially when significant debridement has occurred. Newer forms of NPWT such as negative pressure wound therapy with instillation and dwell time (NPWTi-d) have shown even greater promise by reducing the time to clear infections and promoting greater debridement with fewer procedures...
October 23, 2018: Curēus
Laurence P Diggs, Jennifer Lobb, Christin Tu, Tamara Osborn, Terence P Wade
No abstract text is available yet for this article.
December 1, 2018: American Surgeon
Takehiro Kado, Takashige Kashimoto, Kohei Yamazaki, Kaho Matsuda, Shunji Ueno
Vibrio vulnificus can cause necrotizing soft tissue infection via exposure through an open wound, and the incubation period in cases of wound infection is only about 16 h. These facts strongly suggest that mechanisms to evade innate immune cell phagocytosis are essential for its pathogenicity. Hydrophobic interaction is one of the binding mechanisms between bacteria and phagocytes. Several factors that maintain cell surface hydrophobicity (CSH) can contribute to anti-phagocytic activity. In this study, we tried to identify V...
December 21, 2018: APMIS: Acta Pathologica, Microbiologica, et Immunologica Scandinavica
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