Primary Necrotizing Fasciitis of the Breast: Combined Use of Hyperbaric Oxygen and Negative-Pressure Wound Therapy to Conserve the Breast

Abstract

Necrotizing fasciitis is a rare but potentially fatal disease. It is even more unusual as a primary disease of the breast. Surgical treatment is required in order to gain control over the spreading infection, and mastectomy is reported to be the most common procedure. We report the first case of an otherwise healthy woman who showed a primary necrotizing fasciitis of the breast, which was treated combining conservative surgery with hyperbaric oxygen and negative-pressure wound therapy. A 39-year-old woman presented to the emergency unit with fever and swelling of her right breast. Physical examination showed edema and erythema of the breast, with bluish blisters on the lower quadrant. Ultrasound and CT scans showed diffuse edema of the entire right breast, with subdermal gas bubbles extending to the fascial planes. A few hours later, the necrotic area extended despite of an antibiotic therapy; selective debridement of all breast necrotic tissue was performed and repeated 7 days later. The hyperbaric oxygen was started immediately after the first surgery and repeated daily for 18 days, and then an NPWT was applied. 45 days after the last debridement, the breast wound was covered with a skin graft. Several months later, an excellent cosmetic result was observed. This is the first case of primary necrotizing fasciitis of the breast treated associating hyperbaric oxygen and negative-pressure wound therapy to surgical debridement only; this combination resulted in a complete recovery with the additional benefit of breast conservation.