, Volume 41, Issue 2, pp 583–587 | Cite as

Multidisciplinary intensive care in extensive necrotizing fasciitis

  • Guo-Wei Tu
  • J. O. Hwabejire
  • Min-Jie Ju
  • Yuan-Feng Yang
  • Guang-Jian Zhang
  • Jian-Wei Xu
  • Zhang-Gang Xue
  • C. Jiang
  • Z. Luo
Case Report


This is a case report of extensive necrotizing fasciitis (NF). A 65-year-old man presented with high fever, pain, swelling, and redness of the perineum, scrotum, and right lower limb. Based on the clinical symptoms and an imaging examination, a diagnosis of NF was made. The patient underwent an extensive exploration followed by daily bedside debridement. A diversion colostomy and six additional debridement procedures on the right thigh and perineum were subsequently performed. Although the patient had an eventful course, he recovered well under a multidisciplinary treatment regimen. The treatment and hospital course of the patient are described.


Necrotizing fasciitis Soft tissue infection Klebsiella pneumoniae 



We sincerely thank Hasan B. Alam, M.D., for kindly revising the original draft. We also thank Dr. Yi-zhou He for drawing the sketch map of the extensive necrotizing soft tissue infection. We would like to thank the patient who kindly supplied us with the vital information described herein.

Conflict of interest



  1. 1.
    de Tullio D, Rossi C, Bolzon S, Scagliarini L, Occhionorelli S. Necrotizing fasciitis: a surgical emergency. Updates Surg. 2010;62:83–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Sarani B, Strong M, Pascual J, Schwab CW. Necrotizing fasciitis: current concepts and review of the Literature. J Am Coll Surg. 2009;208:279–88.PubMedCrossRefGoogle Scholar
  3. 3.
    Anaya DA, Dellinger EP. Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis. 2007;44:705–10.PubMedCrossRefGoogle Scholar
  4. 4.
    Awsakulsutthi S. A retrospective review of necrotizing fasciitis in Thammasat University Hospital. J Med Assoc Thai. 2010;93:S246–53.PubMedGoogle Scholar
  5. 5.
    Chiang SR, Chuang YC. Vibrio vulnificus infection: clinical manifestations, pathogenesis, and antimicrobial therapy. J Microbiol Immunol Infect. 2003;36:81–8.PubMedGoogle Scholar
  6. 6.
    Wong CH, Wang YS. The diagnosis of necrotizing fasciitis. Curr Opin Infect Dis. 2005;18:101–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Ustin JS, Malangoni MA. Necrotizing soft-tissue infections. Crit Care Med. 2011;39:2156–62.PubMedCrossRefGoogle Scholar
  8. 8.
    Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving sepsis campaign: International guidelines for the management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36:296–327.PubMedCrossRefGoogle Scholar
  9. 9.
    Mohr JF 3rd. Update on the efficacy and tolerability of meropenem in the treatment of serious bacterial infections. Clin Infect Dis. 2008;47:S41–51.PubMedCrossRefGoogle Scholar
  10. 10.
    Ulivieri S, Toninelli S, Petrini C, Giorgio A, Oliveri G. Prevention of post-operative infections in spine surgery by wound irrigation with a solution of povidone-iodine and hydrogen peroxide. Arch Orthop Trauma Surg. 2011;131:1203–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Sutherland R, Boon RJ, Griffin KE, Masters PJ, Slocombe B, White AR. Antibacterial activity of mupirocin (pseudomonic acid), a new antibiotic for topical use. Antimicrob Agents Chemother. 1985;27:495–8.PubMedCrossRefGoogle Scholar
  12. 12.
    McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. Determinants of mortality for necrotizing soft-tissue infections. Ann Surg. 1995;221:558–63. (discussion pp 563–55).PubMedCrossRefGoogle Scholar
  13. 13.
    Lille ST, Sato TT, Engrav LH, Foy H, Jurkovich GJ. Necrotizing soft tissue infections: obstacles in diagnosis. J Am Coll Surg. 1996;182:7–11.PubMedGoogle Scholar
  14. 14.
    Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am. 2003;85:1454–60.PubMedGoogle Scholar
  15. 15.
    Elliott DC, Kufera JA, Myers RA. Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Ann Surg. 1996;224:672–83.PubMedCrossRefGoogle Scholar
  16. 16.
    File TM Jr. Tan JS, DiPersio JR. Group A streptococcal necrotizing fasciitis. Diagnosing and treating the “flesh-eating bacteria syndrome”. Cleve Clin J Med. 1998;65:241–9.PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Guo-Wei Tu
    • 1
  • J. O. Hwabejire
    • 2
  • Min-Jie Ju
    • 1
  • Yuan-Feng Yang
    • 3
  • Guang-Jian Zhang
    • 4
  • Jian-Wei Xu
    • 5
  • Zhang-Gang Xue
    • 1
  • C. Jiang
    • 4
  • Z. Luo
    • 1
  1. 1.Department of Anesthesiology and Surgical Intensive Care Unit, Zhongshan HospitalFudan UniversityShanghaiChina
  2. 2.Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  3. 3.Department of Urology, Zhongshan HospitalFudan UniversityShanghaiChina
  4. 4.Department of Orthopedics, Zhongshan HospitalFudan UniversityShanghaiChina
  5. 5.Department of Plastic and Reconstructive Surgery, Zhongshan HospitalFudan UniversityShanghaiChina

Personalised recommendations