• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.28 no.1
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• pp.74-80
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• 2002

Necrotizing fasciitis is rare acute infection showing rapidly necrosis involve the subcutaneous tissue and fascia. If treatment is delayed, infection can spread to involve the subcutaneous tissue, skin, deep fascia, and even muscle in rapid sequence, resulting in widespread necrosis and moderate to severe systemic toxicity. Most commonly this disease presents in the extremities, trunk, and perineum; it is relatively rare in the head and neck regions. If not diagnosed and treated in its early stages, necrotizing fasciitis can be potentially fatal, with a motality rate approaching 40%. Historically, the clinical entity now referred to as necrotizing fasciitis was described in the literature under various name. : hospital gangrene, necrotizing erysipelas, streptococcal gangrene, suppurative fasciitis. Necrotizing fasciitis was first described by Wilson in 1952. We experienced 3 cases of necrotizing fasciitis and will report review of literature with diagnosis, treatment, complication and consideration.

• Archives of Plastic Surgery
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• v.34 no.3
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• pp.319-324
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• 2007

Purpose: Necrotizing fasciitis is a rapid progressive, life-threatening disease. Many organisms have been identified for causative pathogens of necrotizing fasciitis. And necrotizing fasciitis caused by Vibrio vulnificus is a matter of grace concern in Southwest seashore of Korea recently. But concrete analysis between these pathogens was not executed yet. Methods: Sixty necrotizing fasciitis patients were included in this study. We divided the patients into 2 groups: Group A was the case which Vibrio vulnificus was cultured for causative pathogen of necrotizing fasciitis, and Group B was the case of other organisms. And we analysed each group for treatment, progression and prognosis. Results: There was no significant difference between two groups in total hospital stay but there was a great difference in ICU stay and progression to septic shock. Also, there was a great difference in mortality within 48 hours but there was no difference in mortality of 48 hours after hospital visit. Conclusion: This indicates that intial management of necrotizing fasciitis cased by Vibrio vulnificus is the key of treatment. So initial medical management with early surgical intervention is necessary for necrotizing fasciitis.

• Clinical and Experimental Pediatrics
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• v.57 no.12
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• pp.538-541
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• 2014

Varicella is usually considered to be a benign disease in healthy children; however, serious complications can occur such as necrotizing fasciitis and toxic shock syndrome. We describe a 38-month-old girl with necrotizing fasciitis and streptococcal toxic shock syndrome following varicella. She was previously healthy and vaccinated against varicella at 12 months of age. She had been diagnosed with varicella three days prior to presenting at our facility; she developed fever, vomiting, and painful swelling on her left flank. Her skin lesions worsened, she became lethargic, and had episodes of hypotension and coagulopathy. Necrotizing fasciitis on the left abdominal wall, buttocks, and left thigh was diagnosed by magnetic resonance imaging, and group A Streptococcus was isolated from a tissue culture. She was diagnosed as necrotizing fasciitis and streptococcal toxic shock syndrome, and successfully treated with repeated surgical debridement and fasciotomy, in addition to intensive antibiotics. Our experience suggests that necrotizing fasciitis in patients with varicella should be considered to be a rare complication even with widespread vaccine use. Early diagnosis and intensive treatment are required to prevent a fatal outcome.

• Journal of Yeungnam Medical Science
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• v.35 no.2
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• pp.248-252
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• 2018

Puerperal sepsis is one of the leading causes of maternal morbidity and mortality worldwide. Postpartum pelvic infections can cause various complications, including wound infections and necrotizing fasciitis. Several microorganisms are known to cause such infections; however, no study has reported on Staphylococcus caprae, a coagulase-negative staphylococcus that is isolated frequently from animals and infrequently from human specimens, as a causative agent. Here, we report a rare case of septic shock complicated by necrotizing fasciitis after a cesarean section. This is the first report of a human isolate of S. caprae in association with puerperal sepsis and necrotizing fasciitis.

• Archives of Plastic Surgery
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• v.38 no.3
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• pp.309-314
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• 2011

Purpose: Necrotizing fasciitis is a life-threatening, destructive soft tissue infection with a very high rate of mortality that needs early diagnosis and aggressive treatment. Systemic Lupus Erythematosus (SLE) is a systemic, autoimmune disease and it's major cause of mortality is an infection. But necrotizing fasciitis in SLE is very rare and there have been only 22 cases reported in the literatures. We reported a patient of necrotizing fasciitis with SLE and reviewed 22 others from literature research. Methods: A 40-year-old female patient with a history of SLE for 6 years came to the emergency room. The patient complained of severe pain and swelling on her right leg. She was diagnosed as necrotizing fasciitis and underwent emergency fasciotomy. As wound cultures showed variable organisms, she was treated with broad-spectrum antibiotics and underwent several surgical debridements. Then, the wound was treated with the V.A.C (Vacuum Assisted Closure) device and split thickness skin grafting was performed two times. Results: Skin graft was well taken within 2 weeks after operations and the patient was discharged to outpatient follow up. There was no complication related with surgery and she could walk without cane after 3 months. Conclusion: We treated a necrotizing fasciitis in a patient with SLE and reviewed 22 others from literature research. The case presented here suggests that necrotizing fasciitis is a rare disease in SLE patients, but should be considered in the differential diagnosis of soft tissue infection in SLE patients. A high index of suspicion is needed for early diagnosis and proper management in these patients.

• Journal of Trauma and Injury
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• v.33 no.4
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• pp.260-263
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• 2020

Necrotizing fasciitis is an infection of the subcutaneous tissue that results in destruction of the fascia and is disproportionately common in patients with chronic liver disease or diabetes. Necrotizing fasciitis of the head and neck is rare, but has a high fatality rate. A 50-year-old man with a past medical history of diabetes reported a chief complaint of a wound in the posterior neck due to trauma. The wound had grown and was accompanied by pus and redness, and the patient had a fever. When the patient was referred to department of plastic & reconstructive surgery, the sternocleidomastoid muscle, semispinalis capitis muscle, splenius capitis muscle, and trapezius muscles were exposed, and the size of the defect was about 25×20 cm. Dead tissue resection was performed before negative-pressure wound therapy, followed by a split-thickness skin graft (STSG). After a 2-week course of aseptic dressing post-STSG, the patient recovered completely. No postoperative complications were observed for 1 year. Necrotizing fasciitis is a life-threatening, rapidly spreading infection, requiring early diagnosis and active surgical treatment. In addition, broad-spectrum antibiotics are required due to the variety of types of causative bacteria. Broad necrotizing fasciitis of the posterior neck is rare, but can quickly progress into a life-threatening stage.

• Archives of Plastic Surgery
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• v.50 no.6
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• pp.610-614
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• 2023

Necrotizing fasciitis is an uncommon yet fatal soft tissue infection. Current recommended treatment includes antibiotics with repeat surgical exploration and wound debridement followed by reconstruction. In burn patients, the Meek micrograft has demonstrated a higher true expansion ratio, faster reepithelialization rate, more resilient toward infection, and reduced risk of graft failure as compared with meshed graft. To our best knowledge, the use of Meek micrografting technique in reconstruction of postdebridement wounds of necrotizing fasciitis has not been reported. Hereby, we present a case of a 57-year-old gentleman who was referred to us for wound reconstruction after surgical debridement of Fournier's gangrene and extensive necrotizing fasciitis involving the anterior abdomen and bilateral femoral region. Meek micrografting technique was used to reconstruct the anterior abdomen as the wound bed was large. Although the graft was complicated with a small area of localized infection, it did not spread across the entire graft and was successfully treated with topical antibiotics and regular wound dressing. In our case, wound reconstruction using Meek micrografting technique in a patient with extensive necrotizing fasciitis was successful and showed positive outcome. Therefore, we suggest further studies to be conducted to investigate the applications and outcomes of the Meek micrografting technique, especially in patients with extensive wound bed and limited donor site availability.

• Journal of Clinical Otolaryngology Head and Neck Surgery
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• v.29 no.2
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• pp.223-228
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• 2018

Background and Objectives : Necortizing fasciitis in the cervical region is a very rare disease with high mortality and morbidity rates. The purpose of this study was to analyze the clinical characteristics, treatment results, complication and prognosis of necrotizing fasciitis patients. Materials and Methods : We retrospectively reviewed the inpatient charts treated for cervical necrotizing fasciitis at our Otorhinolaryngology clinic. We diagnosed necrotizing fasciitis by the clinical findings such as swelling, redness and pain of infected area and necrosis of subcutaneous fat layer and fascia observed during surgery. Twenty such patients were identified and treated from January 2011 to December 2016. Results : 20 adults consisting of 14 male and 6 females with cervical necrotizing fasciitis were diagnosed and treated. The most commonly known associated preceding illness were dental abscess and tonsillitis. The most pathogen was Streptococcus species (12/20), followed by Klebsiella pneumonia (6/20), Staphylococcus species (2/20). The mean duration of hospitalization was 32.2 days (range,14-86). The mean Modified Laboroatory Risk Indicator for Necrotizing Fasciitis (M-LRINEC) score is 7.4 and more than 4 points was eighteen. All patients received parenteral antibiotics and surgical drainage after admission. Conclusions : The reason for the high survival rate in the study was the early diagnosis, as well as the early surgical procedure and antibiotics. After the operation, frequent betadine irrigation could improve the patient's condition and recover without severe complication.

• Archives of Plastic Surgery
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• v.34 no.3
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• pp.383-387
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• 2007

Purpose: A necrotizing fasciitis is a rare, but insidiously advancing fatal soft tissue infection characterized by extensive fascial necrosis. Diagnosis & treatment of this disease are difficult. Necrotizing fasciitis tend to begin with constitutional symptoms of fever and chills. Quite a many lab studies and imaging studies such as standard radiography, computerized tomography can be used, but nothing can confine the extent of affected tissue. Aggressive surgical interventions are often required because of large skin and soft tissue deformity. However, many patients with necrotizing fasciitis are not healthy enough to overcome aggressive surgical intervention. Methods: Since 2000, we treated 10 patients with necrotizing fasciitis. In 4 patients, we used magnetic resonance imaging(MRI) as a tool for diagnosis as soon as necrotizing fascitiis was doubted. We treated patients with delayed coverage with Alloderm$^{(R)}$ & split thickness skin graft or delayed wound closure in as many cases as possible. Results: In 4 patients using preoperative MRI, diagnosis could be made in earlier stage of the disease compared to other patients. Our treatment modality was debridement and coverage with Alloderm$^{(R)}$ & split thickness skin graft. We could reconstruct deformities without significant limitation of movement in 7 cases. Conclusion: We diagnosed and treated 10 necrotizing fasciitis with MRI and Alloderm$^{(R)}$ graft, and results were good.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.6
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• pp.580-587
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• 2006

Necrotizing fasciitis has been recognized as a potentially lethal and rapidly progressing infection. Necrotizing fasciitis of head and neck area is rare but fatal disease that should be prompt diagnosis and recognition. If not promptly recognized and treated, infection can spread into the deep spaces of the neck and compromise the airway. It may also spread into the mediastimum producing life threatening sepsis. In this report, we describe the treatment of 4 cases of necrotizing fasciitis of head and neck area and discuss diagnosis, treatment, complication and consideration with review of literatures.