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Bilateral necrotizing fasciitis of the breast following quadrantectomy

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Abstract

Necrotizing fasciitis (NF) is a rare and highly lethal soft-tissue infection that involves the skin, subcutaneous tissue, and fascia. Although it can affect any part of the body, the breast is seldom involved. We describe a case of bilateral NF of the breast following elective quadrantectomy, successfully treated with antibiotics, bilateral mastectomy, and a vacuum-assisted wound closure system.

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References

  1. Deodhar SD, Shirahatti RG, Sareen AA, Bharucha MA, Bhave GG. Necrotising fasciitis (a report of 5 cases). J Postgrad Med. 1985;31:170–2.

    CAS  PubMed  Google Scholar 

  2. Singh G, Sinha SK, Adhikary S, Babu KS, Ray P, Khanna SK. Necrotising infections of soft tissues—a clinical profile. Eur J Surg. 2002;168:366–71.

    Article  PubMed  Google Scholar 

  3. Childers BJ, Potyondy LD, Nachreiner R, Rogeres FR, Childers ER, Oberg KC, et al. Necrotizing fasciitis: a fourteen-year retrospective study of 163 consecutive patients. Am Surg. 2002;68:109–16.

    PubMed  Google Scholar 

  4. Eugster T, Aeberhard P, Reist K, Sakmann K. Necrotizing fasciitis cause by beta-hemolytic streptococci with fatal outcome—a case report. Swiss Surg. 1997;3:117–20.

    CAS  PubMed  Google Scholar 

  5. Olsen RJ, Musser JM. Molecular pathogenesis of necrotizing fasciitis. Annu Rev Pathol. 2010;5:1–31.

    Article  CAS  PubMed  Google Scholar 

  6. Cainzos M, Gonzalez-Rodriguez FJ. Necrotizing soft tissue infections. Curr Opin Crit Care. 2007;13:433–9.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. Cuschieri J. Necrotizing soft tissue infection. Surg Infect (Larchmt). 2008;9:559–62.

    Article  Google Scholar 

  9. Cheng NC, Su YM, Kuo YS, Tai HC, Tang YB. Factors affecting the mortality of necrotizing fasciitis involving the upper extremities. Surg Today. 2008;38:1108–13.

    Article  PubMed  Google Scholar 

  10. Salcido R. Necrotizing fasciitis: reviewing the causes and treatment strategies. Adv Skin Wound Care. 2007;20:288–93.

    Article  PubMed  Google Scholar 

  11. Velchuru V, Van Der Walt M, Sturzaker H. Necrotising fasciitis in a postmastectomy wound. Breast J. 2006;1:72–4.

    Article  Google Scholar 

  12. Gehlen JMLG, Luyer MDP, Keymeulen K, Greve JW. Necrotizing fasciitis following modified radical mastectomy. Breast J. 2008;14:198–200.

    Article  Google Scholar 

  13. Flandrin A, Rouleau C, Azar C, Dubon O, Giacalone PL. First report of a necrotising fasciitis of the breast following a core needle biopsy. Breast J. 2009;15:199–201.

    Article  PubMed  Google Scholar 

  14. Shah J, Sharma K, O’Donoghue JM, Mearns B, Johri A, Thomas V. Necrotising fasciitis of the breast. Br J Plast Surg. 2001;54:67–8.

    Article  CAS  PubMed  Google Scholar 

  15. Villar-Compte D, Jacquemin B, Robles-Vidal C, Volkow P. Surgical site infections in breast surgery: case-control study. World J Surg. 2004;28:242–6.

    Article  Google Scholar 

  16. McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. Determinants of mortality for necrotizing soft tissue infections. Ann Surg. 1995;221:558–63.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Elliott DC, Kufera JA, Myers RA. Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Ann Surg. 1996;224:672–83.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Wong CH, Chang CH, Pasupathy S, Khin LW, Tan JL, Low CO. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Jt Surg Am. 2003;85:1454–60.

    Google Scholar 

  19. Nizami S, Mohiuddin K, Mohsin-e-Azam, Zafr H, Memon MA. Necrotising fasciitis of the breast. Breast J. 2006;12:168–9.

  20. Rajakannu M, Kate V, Ananthakrishnan N. Necrotizing infection of the breast mimicking carcinoma. Breast J. 2006;12:266–7.

    Article  PubMed  Google Scholar 

  21. Hanif MA, Bradley MJ. Sonographic findings of necrotizing fasciitis in the breast. J Clin Ultrasound. 2008;36:517–9.

    Article  PubMed  Google Scholar 

  22. Wong CH, Tan BK. Necrotizing fasciitis of the breast. Plast Reconstr Surg. 2008;122:151e–2e.

    Article  PubMed  Google Scholar 

  23. Keune JD, Melby S, Kirby JP, Aft RL. Shared management of a rare necrotizing soft tissue infection of the breast. Breast J. 2009;15:321–3.

    Article  PubMed  Google Scholar 

  24. Lopez FA, Lartchenko S. Skin and soft tissue infections. Infect Dis Clin North Am. 2006;20:759–72.

    Article  PubMed  Google Scholar 

  25. 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;32:1535–41.

    Article  PubMed  Google Scholar 

  26. Kuncir EJ, Tillou A, St Hill CR, Petrone P, Kimbrill B, Asensio JA. Necrotizing soft-tissue infections. Emerg Med Clin North Am. 2003;21:1075–87.

    Article  PubMed  Google Scholar 

  27. Rogers RL, Perkins J. Skin and soft tissue infections. Prim Care. 2006;33:697–710.

    Article  PubMed  Google Scholar 

  28. Brothers TE, Tagge DU, Stutley JE, Conway WF, Del Schutte H, Byrne TK Jr. Magnetic resonance imaging differentiates between necrotizing and non-necrotizing fasciitis of the lower extremity. J Am Coll Surg. 1998;187:416–21.

    Article  CAS  PubMed  Google Scholar 

  29. Mossa-Basha M, van Holsbeeck M. Musculoskeletal Infection. Ultrasound Clin. 2007;2:639–53.

    Article  Google Scholar 

  30. Hocken DB, Dussek JE. Streptococcus milleri as a cause of pleural empyema. Thorax. 1985;40:626–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Porta G, Rodriguez-Carballeira M, Gomez L, Salavert M, Freixas N, Xercavins M, et al. Thoracic infections caused by Streptococcus milleri. Eur Respir J. 1998;12:357–62.

    Article  CAS  PubMed  Google Scholar 

  32. Wong CA, Donald F, Macfarlane JT. Streptococcus milleri pulmonary disease: a review and clinical description of 25 patients. Thorax. 1995;50:1093–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Ward RG, Walsh MS. Necrotizing fasciitis: 10 years’ experience in a district general hospital. Br J Surg. 1991;78:488–9.

    Article  CAS  PubMed  Google Scholar 

  34. Hsia GH, Chang Ch, Hsiao CW, Fanchiang JH, Jee SH. Necrotizing soft tissue infections. Surgical or conservative treatment? Dermatol Surg. 1998;24:243–7 (discussion 247–8).

  35. Sjogren J, Mokhtari A, Gustafsson R, Malmsjö M, Nilsson J, Ingemansson R. Vacuum-assisted closure therapy for deep sternal wound infections: the impact of learning curve on survival and predictors for late mortality. Int Wound J. 2008;5:216–23.

    Article  PubMed  Google Scholar 

  36. Reiss N, Schuett U, Kemper M, Bairaktaris A, Koerfer R. New method for sternal closure after vacuum-assisted therapy in deep sternal infections after cardiac surgery. Ann Thorac Surg. 2007;83:2246–7.

    Article  PubMed  Google Scholar 

  37. Salazard B, Niddam J, Ghez O, Metras D, Magalon G. Vacuum-assisted closure in the treatment of poststernotomy mediastinitis in the paediatric patient. J Plast Reconstr Aesthet Surg. 2008;61:302–5.

    Article  CAS  PubMed  Google Scholar 

  38. Fleck T, Gustafsson R, Harding K, Ingemansson R, Lirtzman MD, Meites HL, et al. The management of deep sternal wound infections using vacuum assisted closure (VAC) therapy. Int Wound J. 2006;3:273–80.

    Article  PubMed  Google Scholar 

  39. Chen Y, Almeida AA, Mitnovetski S, Goldstein J, Lowe C, Smith JA. Managing deep sternal wound infections with vacuum-assisted closure. ANZ J Surg. 2008;78:333–6.

    Article  PubMed  Google Scholar 

  40. Huang WS, Hsieh SC, Hsieh CS, Schoung JY, Huang T. Use of vacuum-assisted wound closure to manage limb wounds in patients suffering from acute necrotizing fasciitis. Asian J Surg. 2006;29:135–9.

    Article  PubMed  Google Scholar 

  41. Steinstraesser L, Sand M, Steinaue HU. Giant VAC in a patient with extensive necrotizing fasciitis. Int J Low Extrem Wounds. 2009;8:28–30.

    Article  PubMed  Google Scholar 

  42. Silberstein J, Grabowski J, Parsons JK. Use of a vacuum-assisted device for Fournier’s gangrene: a new paradigm. Rev Urol. 2008;10:76–80.

    PubMed Central  PubMed  Google Scholar 

  43. Stoeckel WT, David L, Levine EA, Argenta AE, Perrier ND. Vacuum-assisted closure for the treatment of complex breast wounds. Breast. 2006;15:610–3.

    Article  PubMed  Google Scholar 

  44. Kendrick AS, Chase CW. Salvage of an infected breast tissue expander with an implant sizer and negative pressure wound management. Plast Reconstr Surg. 2008;121:138e–9e.

    Article  PubMed  Google Scholar 

  45. Erba P, Rieger UM, Pierer G, Kalbermatten DF. Vacuum-assisted closures (VAC) for venous congestion of the nipple-areola complex. J Plast Reconstr Aesthet Surg. 2008;61:852–4.

    Article  PubMed  Google Scholar 

  46. Lia EC, Breuing KH. Breast mound salvage using vacuum-assisted closure device as bridge to reconstruction with inferolateral AlloDerm hammock. Ann Plast Surg. 2007;59:218–24.

    Article  Google Scholar 

  47. Ozturk E, Ozquc H, Yilmazlar T. The use of vacuum-assisted closure therapy in the management of Fournier’s gangrene. Am J Surg. 2009;197:660–5.

    Article  PubMed  Google Scholar 

  48. Dm Schaffzin, Douglas JM. Vacuum-assisted closure of complex perineal wounds. Dis Colon Rectum. 2004;47:1745–8.

    Article  Google Scholar 

  49. Phelps JR, Faga R, Pirela-Cruz MA. A case study of negative pressure wound therapy to manage acute necrotizing fasciitis. Ostomy Wound Manag. 2006;52:54–9.

    Google Scholar 

  50. de Geus HRH, van der Klooster JM. Vacuum-assisted closure in the treatment of large skin defects due to necrotizing fasciitis. Intensive Care Med. 2006;31:601.

    Google Scholar 

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Consent

Written informed consent was obtained from the patient for publication of this case report and its images.

Acknowledgments

We thank the Department of Pathology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia for providing images of the slides.

Conflict of interest

No competing financial interests exist.

Author information

Authors and Affiliations

  1. Division of Experimental Therapeutics, Toronto General Research Institute, Room 4-425, 67 College Street, Toronto, ON, M5G 2M1, Canada

    Fernando A. Angarita

  2. Peter A. Silverman Centre for International Health, Mount Sinai Hospital, Toronto, ON, Canada

    Sergio A. Acuna

  3. Department of Surgery, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia

    Lilian Torregrosa, Mauricio Tawil, Elio F. Sánchez, Oscar Heilbron & Luis Carlos Domínguez

  4. Breast and Soft Tissue Clinic, Centro Javeriano de Oncología, Bogotá, Colombia

    Lilian Torregrosa & Mauricio Tawil

Authors
  1. Fernando A. Angarita
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  2. Sergio A. Acuna
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  3. Lilian Torregrosa
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  4. Mauricio Tawil
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  5. Elio F. Sánchez
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  7. Luis Carlos Domínguez
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Corresponding author

Correspondence to Fernando A. Angarita.

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Angarita, F.A., Acuna, S.A., Torregrosa, L. et al. Bilateral necrotizing fasciitis of the breast following quadrantectomy. Breast Cancer 21, 108–114 (2014). https://doi.org/10.1007/s12282-010-0219-4

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  • DOI: https://doi.org/10.1007/s12282-010-0219-4

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