• 대한기관식도과학회지
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• 제17권1호
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• pp.46-49
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• 2011

Background and Objectives Cervical necrotizing fasciitis is a fulminant disease associated with necrosis of connective tissue, spread along the fascial plane, and high mortality. We analyzed the clinical characteristics and treatment outcome of this rare fatal disease. Materials and Methods We retrospectively reviewed the medical records of 19 patients treated for cervical necrotizing fasciitis from January 1999 to January 2009. Mean age was 53.7 years. Results The most common predisposing illness was tonsillitis (36.8%), followed by odontogenic infection (15.7%). Diabetes mellitus was most common underlying disease. Liver cirrhosis and chronic renal failure were found in 2 patients each. All patients were treated with combination of parenteral antibiotics and wide surgical debridement by transcervical and/or thoracotomy approach. Multiple surgical debridements were performed in 7 patients. Tracheotomy was performed in most of the patients (88.8%). Period of total hospitalization and Intensive care unit was 23 days and 10.1 days. Two patients died of disease and overall survival rate was 89.4%. Conclusion Early surgical management and care in intensive care unit are essential for cervical necrotizing fasciitis. Possible complications such as respiratory failure, mediastinitis or sepsis should be carefully evaluated.

• Archives of Plastic Surgery
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• 제32권5호
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• pp.663-666
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• 2005

Mandible angle ostectomy is the most widely-operated facial contour surgery. We experienced a rare case of necrotizing fasciitis of the lower leg following mandible angle ostectomy. A 20 years old female visited our department 5 days after mandible angle ostectomy. At the time, she was diagnosed as sepsis and on her 2nd admission day, she was diagnosed as necrotizing fasciitis on her left leg. She was treated by fasciotomy and necrotized tissue removal. Necrotizing fasciitis is a rare complication of any kinds of operation but once it develops, it causes fatal results, especially to cosmetic surgeries. Early diagnosis and aggressive operation is known as only treatment for the disease.

• 대한두개안면성형외과학회지
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• 제13권2호
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• pp.147-150
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• 2012

Purpose: Varicella-zoster virus (VZV) infection is a common childhood disease. However, old and immune compromised patients are also at risk. Necrotizing fasciitis is a life threatening infection of the subcutaneous tissues, rapidly extending along the fascial planes. It is associated with a significant mortality rate, reported between 20% and 50%, and is therefore regarded as a surgical emergency. The authors treated a patient, who developed skin necrosis of her nose and left hemifacial area, following VZV infection. There are few literatures concerning this case; therefore, we present a rare case with review of literature. Methods: A 39-year-old woman had shown a localized, painful, multiple bullae and eschar formation in her nose and left hemifacial area for several days. Her skin lesion had rapidly worsened in size and morphology. Results: We diagnosed her as a necrotizing fasciitis, following herpes zoster, and then we performed a debridement of necrotic tissue and took a full thickness skin graft on her nose and left hemifacial area. Now, she was followed up with acceptable aesthetic result after 6 months. Conclusion: Secondary bacterial skin infection following VZV, can cause a result in a higher risk of complications. Among the complication, a necrotizing fasciitis of the head and neck is uncommon, and involvement of the nose is even more rare. Through this uncommon case report, we intend to emphasize the fact that early diagnosis of necrotizing fasciitis is very important, since it frequently necessitates surgical treatment which improves morbidity and leads to good recovery.

• 대한기관식도과학회지
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• 제17권1호
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• pp.61-64
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• 2011

Cervical necrotizing fasciitis is a rare but well known life-threatening soft tissue infection primarily affecting the superficial and deep cervial fascial planes. It may rapidly spread into the mediastinum along fascial planes. So, if proper diagnosis and prompt surgical debridement is delayed, the infection may cause descending necrotizing mediastinitis with extensive necrosis of overlying skin, destroying fascia and muscle. Therefore, the key to the successful outcome is early recognition and rapid initiation of definitive radical debridement. The authors report, along with a literature review, a case of cervical necrotizing fasciitis with atypical spreading into the lateral chest wall.

• Archives of Plastic Surgery
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• 제41권1호
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• pp.81-84
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• 2014

In this article, we present two cases of femoral pseudoaneurysm (PA) at the femoral arterial puncture site followed by necrotizing fasciitis, which is rare but can be fatal when not managed appropriately. PA was revealed by lower-extremity angiography and color-flow Doppler ultrasonography. Hematoma removal, thrombolysis, and bleeder ligation with Gelfoam were repeatedly performed by a vascular surgeon. When necrotizing fasciitis developed, aggressive surgical drainage and creation of a viable wound bed for reconstruction were mandatory. We adopted a vacuum-assisted closure device (Kinetics Concepts International) as the standard treatment for complicated, serious, infected PA of the puncture site. Excellent clinical outcomes were obtained.

• Neonatal Medicine
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• 제18권1호
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• pp.148-152
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• 2011

괴사성 근막염은 급격히 진행되는 심부 연 조직 감염으로 주로 면역 저하나 당뇨를 앓고 있는 성인에서 발병하나 드물게 신생아에서도 생길 수 있으며, 감염 초기에 괴사 조직을 제거하는 수술을 포함한 적절한 치료가 이루어지지 않으면 사망에 이르는 매우 위험한 질환이다. 그러나 증상과 이학적 소견이 비특이적이고 매우 드물게 발생하므로 때로는 진단과 치료가 늦어지기도 한다. 그러므로, 피부 또는 피하 조직 감염 소견을 보이는 모든 환아에게서 항상 심부 조직 감염의 가능성을 염두에 두고 진단적, 치료적 접근이 이루어져야 하겠다. 저자는 생후 7일째인 건강한 만삭 신생아에서 특별한 선행 요인 없이 지역 획득 메티실린 내성 황색포도상 구균에 의해 발생한 괴사성 근막염을 경험하였기에 보고하는 바이다.

• 척추신경추나의학회지
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• 제13권2호
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• pp.85-95
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• 2018

Objectives : The aim of the present study was to report the clinical progress of a patient who underwent surgical treatment of necrotizing fasciitis. Methods : During the admission period, The patient was treated with acupuncture, cupping, Korean Medicine, Chuna therapy every day and observed by Numeric Rating Scale(NRS), Pain Disability Index(PDI), Beck Depression Inventory(BDI), and assessment about range of motion(ROM) and manual muscle test(MMT) for hip & knee joint. Results : After treated by using above treatment, NRS, PDI, BDI and ROM, MMT were improved. Conclusions : Korean Medical treatment are estimated to be good for patients after surgical treatment of necrotizing fasciitis. But more cases are required to prove the effectiveness of the treatment.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제23권1호
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• pp.77-81
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• 2001

경안명 괴사성 근막염은 높은 사망률을 가진 치명적인 질환이나 혈류가 풍부한 두경부에서는 거의 발생하지 않고 피부에 괴사를 보이지 않는 경우도 많아 두경부에 발생한 감염증의 진단시에 그 가능성을 고려하지 않는 오류를 범하기 쉽다. 따라서, 일단 발생한 경우 오진 또는 뒤늦은 진단으로 환자의 생명을 위협하게 될 수 있다. 이의 진단에는 임상적 검사상 촉진시 느껴지는 염발음이 가장 중요하고 이환 부위의 종창, 악취, 지저분하고 창백하며 붉은 빛을 띠는 피부 표면의 모습, 절개 시 회색빛의 구정물과 같은 삼출물 등이 참고자료가 될 수 있으며, 컴퓨터 단층사진의 촬영을 통해 피하조직의 공기 방울이나 공기 주머니를 확인하고 hemolytic Streptococci등의 균배양 결과를 종합적으로 판단함으로써 더욱 정확한 진단이 가능해지고, 치료방법으로는 빠르고 광범위한 외과적 처치와 대량의 항생제 투여가 가장 중요하고 고압산소요법 등 기타 보조적 처치법을 적절히 시행한다면 좋은 결과를 얻을 수 있을 것으로 사료되었다.

• Archives of Plastic Surgery
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• 제36권3호
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• pp.351-355
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• 2009

Purpose: Cervical necrotizing fasciitis tends to involve the deep soft tissues and spread caudally to the anterior chest and mediastinum, often resulting in major complications and death. It may rapidly spread into the thorax along fascial planes, and the associated diagnostic delay results in this descending necrotizing mediastinitis. So, aggressive multidisciplinary therapy with surgical drainage is mandatory. We present a very rare case of descending necrotizing mediastinitis with literature review. Methods: A 53 years old male visited our department 7 days after trauma in neck. His premorbid conditions and risk factors of necrotizing fasciitis were concealed hepatoma, trauma history, chronic liver disease, and nutrition deficit. Computed tomographic scans of the head and neck region were performed in this patient : signs of necrotizing fasciitis, were seen in the platysma, sternocleidomastoid, trapezius muscle and strap muscles of the neck. Fluid accumulations involved multiple neck spaces and mediastinum. At the time, he diagnosed as necrotizing fasciitis on his neck and anterior chest. Necrotic wound was excised serially and we treated this with the Vacuum - assisted closure(VAC, Kinetics Concepts International, San Antonio, Texas) system device. After appropriately shaping the sponge and achieving additional 3 pieces drainage tubes in the pockets, continuous negative pressure of 125 mmHg was applied. The VAC therapy was utilized for a period of 12 days. Results: We obtained satisfactory results from wide excision, abscess drainage with the VAC system, and then split thickness skin graft. The postoperative course was uneventful. Conclusion: The refined technique using the VAC system can provide a means of simple and effective management for the descending necrotizing mediastinitis, with better cosmetic and functional results. Finally, the VAC system has been adopted as the standard treatment for deep cervical and mediastinal wound infections as a result of the excellent clinical outcome.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제41권2호
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• pp.90-96
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• 2015

Necrotizing fasciitis (NF) is an infection that spreads along the fascial planes, causing subcutaneous tissue death characterized by rapid progression, systemic toxicity, and even death. NF often appears as a red, hot, painful, and swollen wound with an ill-defined border. As the infective process continues, local pain is replaced by numbness or analgesia. As the disease process continues, the skin initially becomes pale, then mottled and purple, and finally, gangrenous. The ability of NF to move rapidly along fascial planes and cause tissue necrosis is secondary to its polymicrobial composition and the synergistic effect of the enzymes produced by the bacteria. Treatment involves securing the airway, broad-spectrum antimicrobial therapy, intensive care support, and prompt surgical debridement, repeated as needed. Reducing mortality rests on early diagnosis and prompt aggressive treatment.