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Fasciitis

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Textbook of Emergency General Surgery

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Abstract

Necrotizing fasciitis (NF) is a rare but life-threatening infection of soft tissue. NF commonly occurs in the subcutaneous tissue and the superficial fascia of the extremities, rapidly spreads throughout the body, and causes sepsis and multiple organ failure. Delayed diagnosis and treatment can cause patient death. However, it is difficult to diagnose the patient as having NF in the early stages. The most useful test is to remove affected tissues surgically though laboratory tests and imaging tests are also helpful for the diagnosis of NF. When you have suspected NF, you should perform surgery to remove infected or necrotic tissues. If necessary, you should debride and amputate a necrotic extremity. You should repeat debridement until infected and necrotic tissues have not been found. You should start empiric antibiotic treatment, and you should change to appropriate antibiotics when the susceptibility of the causative bacteria is revealed. However, the mortality rate is high, even if appropriate treatment has been performed. It is important that you perform surgery as soon as possible.

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References

  1. Glass G, Sheil F, Ruston J, Butler P. Necrotising soft tissue infection in a UK metropolitan population. Ann R Coll Surg Engl. 2015;97(1):46–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Naseer U, Steinbakk M, Blystad H, Caugant DA. Epidemiology of invasive group A streptococcal infections in Norway 2010–2014: a retrospective cohort study. Eur J Clin Microbiol Infect Dis. 2016;35(10):1639–48.

    Article  CAS  PubMed  Google Scholar 

  3. Nelson GE, Pondo T, Toews KA, Farley MM, Lindegren ML, Lynfield R, et al. Epidemiology of invasive group A Streptococcal infections in the United States, 2005–2012. Clin Infect Dis. 2016;63(4):478–86.

    Article  PubMed  Google Scholar 

  4. Bocking N, Matsumoto C-L, Loewen K, Teatero S, Marchand-Austin A, Gordon J, et al. High incidence of invasive group A Streptococcal infections in remote indigenous communities in Northwestern Ontario, Canada. Open Forum Infect Dis. 2017;4(1):ofw243.

    Article  PubMed  Google Scholar 

  5. Lancerotto L, Tocco I, Salmaso R, Vindigni V, Bassetto F. Necrotizing fasciitis: classification, diagnosis, and management. J Trauma Acute Care Surg. 2012;72(3):560–6.

    Article  PubMed  Google Scholar 

  6. Stevens DL, Bryant AE. Necrotizing soft-tissue infections. N Engl J Med. 2017;377(23):2253–65.

    Article  PubMed  Google Scholar 

  7. Hua C, Bosc R, Sbidian E, De Prost N, Hughes C, Jabre P, et al. Interventions for necrotizing soft tissue infections in adults. Cochrane Database Syst Rev. 2018;5(5):CD011680.

    PubMed  Google Scholar 

  8. Morgan MS. Diagnosis and management of necrotising fasciitis: a multiparametric approach. J Hosp Infect. 2010;75(4):249–57.

    Article  CAS  PubMed  Google Scholar 

  9. Fais P, Viero A, Viel G, Giordano R, Raniero D, Kusstatscher S, et al. Necrotizing fasciitis: case series and review of the literature on clinical and medico-legal diagnostic challenges. Int J Legal Med. 2018;132(5):1357–66.

    Article  PubMed  Google Scholar 

  10. McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. Determinants of mortality for necrotizing soft-tissue infections. Ann Surg. 1995;221(5):558–63; discussion 563–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004;32(7):1535–41.

    Article  PubMed  Google Scholar 

  12. Fernando SM, Tran A, Cheng W, Rochwerg B, Kyeremanteng K, Seely AJE, et al. Necrotizing soft tissue infection: diagnostic accuracy of physical examination, imaging, and LRINEC score: a systematic review and meta-analysis. Ann Surg. 2019;269(1):58–65.

    Article  PubMed  Google Scholar 

  13. Carbonetti F, Cremona A, Carusi V, Guidi M, Iannicelli E, Di Girolamo M, et al. The role of contrast enhanced computed tomography in the diagnosis of necrotizing fasciitis and comparison with the laboratory risk indicator for necrotizing fasciitis (LRINEC). Radiol Med. 2016;121(2):106–21.

    Article  PubMed  Google Scholar 

  14. Kim K-T, Kim YJ, Won Lee J, Kim YJ, Park S-W, Lim MK, et al. Can necrotizing infectious fasciitis be differentiated from nonnecrotizing infectious fasciitis with MR imaging? Radiology. 2011;259(3):816–24.

    Article  PubMed  Google Scholar 

  15. Magalhães L, Martins SRP, Nogué R. The role of point-of-care ultrasound in the diagnosis and management of necrotizing soft tissue infections. Ultrasound J. 2020;12(1):3.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Majeski J, Majeski E. Necrotizing fasciitis: improved survival with early recognition by tissue biopsy and aggressive surgical treatment. South Med J. 1997;90(11):1065–8.

    Article  CAS  PubMed  Google Scholar 

  17. Nawijn F, Hietbrink F, Van Dijk MR. Getting it right the first time: frozen sections for diagnosing necrotizing soft tissue infections. World J Surg. 2021;45(1):148–59.

    Article  PubMed  Google Scholar 

  18. Alayed KA, Tan C, Daneman N. Red flags for necrotizing fasciitis: a case control study. Int J Infect Dis. 2015;36:15–20.

    Article  PubMed  Google Scholar 

  19. Bucca K, Spencer R, Orford N, Cattigan C, Athan E, McDonald A. Early diagnosis and treatment of necrotizing fasciitis can improve survival: an observational intensive care unit cohort study. ANZ J Surg. 2013;83(5):365–70.

    Article  PubMed  Google Scholar 

  20. Nawijn F, Smeeing DPJ, Houwert RM, Leenen LPH, Hietbrink F. Time is of the essence when treating necrotizing soft tissue infections: a systematic review and meta-analysis. World J Emerg Surg. 2020;15(1):4.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis. 2014;59(2):147–59.

    Article  PubMed  Google Scholar 

  22. Sartelli M, Guirao X, Hardcastle TC, Kluger Y, Boermeester MA, Rasa K, et al. 2018 WSES/SIS-E consensus conference: recommendations for the management of skin and soft-tissue infections. World J Emerg Surg. 2018;13:58.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Goldstein EJC, Anaya DA, Dellinger EP. Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis. 2007;44(5):705–10.

    Article  Google Scholar 

  24. Baharestani MM. Negative pressure wound therapy in the adjunctive management of necrotizing fascitis: examining clinical outcomes. Ostomy Wound Manage. 2008;54(4):44–50.

    PubMed  Google Scholar 

  25. Lee J, Jung H, Kwon H, Jung S-N. Extended negative pressure wound therapy-assisted dermatotraction for the closure of large open fasciotomy wounds in necrotizing fasciitis patients. World J Emerg Surg. 2014;9(1):29.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Orgill DP, Manders EK, Sumpio BE, Lee RC, Attinger CE, Gurtner GC, et al. The mechanisms of action of vacuum assisted closure: more to learn. Surgery. 2009;146(1):40–51.

    Article  PubMed  Google Scholar 

  27. Darenberg J, Ihendyane N, Sjolin J, Aufwerber E, Haidl S, Follin P, et al. Intravenous immunoglobulin G therapy in streptococcal toxic shock syndrome: a European randomized, double-blind, placebo-controlled trial. Clin Infect Dis. 2003;37(3):333–40.

    Article  CAS  PubMed  Google Scholar 

  28. Kaul R, McGeer A, Norrby-Teglund A, Kotb M, Schwartz B, O’Rourke K, et al. Intravenous immunoglobulin therapy for streptococcal toxic shock syndrome—a comparative observational study. Clin Infect Dis. 1999;28(4):800–7.

    Article  CAS  PubMed  Google Scholar 

  29. Kadri SS, Swihart BJ, Bonne SL, Hohmann SF, Hennessy LV, Louras P, et al. Impact of intravenous immunoglobulin on survival in necrotizing fasciitis with vasopressor-dependent shock: a propensity-score matched analysis from 130 US hospitals. Clin Infect Dis. 2017;64(7):877–85.

    PubMed  Google Scholar 

  30. Shaw JJ, Psoinos C, Emhoff TA, Shah SA, Santry HP. Not just full of hot air: hyperbaric oxygen therapy increases survival in cases of necrotizing soft tissue infections. Surg Infect. 2014;15(3):328–35.

    Article  Google Scholar 

  31. Devaney B, Frawley G, Frawley L, Pilcher DV. Necrotising soft tissue infections: the effect of hyperbaric oxygen on mortality. Anaesth Intensive Care. 2015;43(6):685–92.

    Article  CAS  PubMed  Google Scholar 

  32. Wang C. Hyperbaric oxygen for treating wounds. Arch Surg. 2003;138(3):272.

    Article  PubMed  Google Scholar 

  33. Willy C, Rieger H, Vogt D. Hyperbaric oxygen therapy for necrotizing soft tissue infections: contra. Chirurg. 2012;83(11):960–72.

    Article  CAS  PubMed  Google Scholar 

  34. Jabbour G, El-Menyar A, Peralta R, Shaikh N, Abdelrahman H, Mudali IN, et al. Pattern and predictors of mortality in necrotizing fasciitis patients in a single tertiary hospital. World J Emerg Surg. 2016;11(1):40.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Van Stigt SFL, De Vries J, Bijker JB, Mollen RMHG, Hekma EJ, Lemson SM, et al. Review of 58 patients with necrotizing fasciitis in the Netherlands. World J Emerg Surg. 2016;11(1):21.

    Article  PubMed  PubMed Central  Google Scholar 

Further Reading

  • Hua C, Bosc R, Sbidian E, De Prost N, Hughes C, Jabre P, et al. Interventions for necrotizing soft tissue infections in adults. Cochrane Database Syst Rev. 2018;5:CD011680.

    PubMed  Google Scholar 

  • Morgan MS. Diagnosis and management of necrotising fasciitis: a multiparametric approach. J Hosp Infect. 2010;75(4):249–57.

    Article  CAS  PubMed  Google Scholar 

  • Sartelli M, Guirao X, Hardcastle TC, Kluger Y, Boermeester MA, Rasa K, et al. 2018 WSES/SIS-E consensus conference: recommendations for the management of skin and soft-tissue infections. World J Emerg Surg. 2018;13:58.

    Article  PubMed  PubMed Central  Google Scholar 

  • Stevens DL, Bryant AE. Necrotizing soft-tissue infections. N Engl J Med. 2017;377(23):2253–65.

    Article  PubMed  Google Scholar 

  • Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis. 2014;59(2):147–59.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Ehime University Hospital, Ehime, Japan

    Yutaka Harima & Norio Sato

  2. Kyoto Medical Center, Kyoto, Japan

    Kaoru Koike

Authors
  1. Yutaka Harima
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  2. Norio Sato
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  3. Kaoru Koike
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Corresponding author

Correspondence to Norio Sato .

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Editors and Affiliations

  1. General, Emergency and Trauma Surgery Dept., Pisa University Hospital, Pisa, Italy

    Federico Coccolini

  2. General and Emergency Surgery Dept., Bufalini Hospital, Cesena, Italy

    Fausto Catena

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Harima, Y., Sato, N., Koike, K. (2023). Fasciitis. In: Coccolini, F., Catena, F. (eds) Textbook of Emergency General Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-22599-4_111

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  • DOI: https://doi.org/10.1007/978-3-031-22599-4_111

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-22598-7

  • Online ISBN: 978-3-031-22599-4

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