OWL: OCOSH Classification/Fasciitis/Necrotizing Fasciitis

Necrotizing Soft Tissue Infections

Wheeless — 2002-02-04 00:54:02 GMT

Wheeless' Textbook of Orthopaedics - necrotizing fascitits is any necrotizing soft tissue infection spreading along fascial planes, with or without overlying cellulitis; - also called Meleney ulcer, NF is severe manifestation of lymphangitis that progresses in a frightening manner within a few hours; - tissue necrosis develops rapidly behind advancing wall of inflammation that limits penetration by antibiotics; - desquamation followed by gangrene may be relentless; - clinical signs of pain, hyperyrexia, and chills are severe; - skin lesions are incised and drained or aspirated to obtain fluid for culture; - initial findings are localized pain and minimal swelling, often w/ no visible trauma or discoloration of the skin; - dermal induration and erythema eventually become evident; - eventually the patient has limited range of motion, chills, fever; - dx is confirmed when a probed can be passed laterally along fascial cleft in a open wound; - blistering of the epidermis is a late finding;

2010 Bowel perforation presenting as subcutaneous emphysema of the thigh CORR Open Access

Saldua et al — 2011-05-04 00:54:02 GMT

Necrotizing fasciitis is recognized as a surgical emergency. Early detection and aggressive surgical d�bridement are crucial to reduce patient mortality and morbidity. There are, however, other causes of subcutaneous emphysema. We present the case of a 64 year-old patient with a history of postsurgical radiation for rectal carcinoma with subcutaneous emphysema of the thigh in the presence of urinary sepsis. Surgical exploration revealed the source of the emphysema to be an enterocutaneous fistula. The patient had an unstable and prolonged hospitalization after d�bridements of the thigh and abdominal surgery and was readmitted for recurrence of thigh drainage, but eventually was discharged; nine months after the initial diagnosis all wounds had healed and he was walking with a walker. Despite an otherwise benign clinical appearance, the radiographic finding of subcutaneous emphysema in the absence of penetrating trauma must be considered a case of a necrotizing soft tissue infection until proven otherwise.
Case report: Bowel perforation presenting as subcutaneous emphysema of the thigh. Saldua NS, Fellars TA, Covey DC. Clin Orthop Relat Res. 2010 Feb;468(2):619-23 (full text)

Bone Joint And Necrotizing Soft Tissue Infections

Mader & Calhoun — 2006-04-02 00:54:02 GMT

Medical Microbiology Section 5. Introduction to Infectious Diseases 100. Bone, Joint, and Necrotizing Soft Tissue Infections Jon T. Mader Jason Calhoun General Concepts Sections include:- Introduction Necrotizing Soft Tissue Infections Crepitant Anaerobic Cellulitis Necrotizing Fasciitis Nonclostridial Myonecrosis Clostridial Myonecrosis Fungal Necrotizing Cellulitis Joint Infections Gonococcal Arthritis Nongonococcal Arthritis Diagnosis of Bacterial Arthritis Granulomatous Arthritis Bone Infections Hematogenous Osteomyelitis Contiguous-Focus Osteomyelitis Chronic Osteomyelitis Diagnosis of Bacterial Osteomyelitis Skeletal Tuberculosis Fungal Osteomyelitis References

Clinical And Micromiological Features Of Necrotizing Fasciitis

Brooks & Frazier — 2006-03-02 00:54:02 GMT

Full text article Journal of Clinical Microbiology Sept 1995 p2382-2387

Combination Of Hbo And Negative Pressure Therapy To Prevent Mortality In Patients With Necrotizing Fasciitis

Weber et al — 2006-04-15 00:54:02 GMT

Poster. Weber et al, Aurora Health Care and Hyperbaric and Wound Care Associates, Milwaukee

Flesh Eating Disease A Note On Necrotizing Fasciitis

H Dele Davies MD MSc — 2006-04-15 00:54:02 GMT

Editorial Paediatrics and Child Health May/June 2001, Volume 6, Number 5 Flesh-eating disease: A note on necrotizing fasciitis H Dele Davies MD MSc, Child Health Research Unit, Alberta Children�s Hospital and Departments of Pediatrics, Microbiology and Infectious Diseases and Community Health Sciences, University of Calgary, Calgary, Alberta There has been much media attention in the past few years to the condition dubbed �flesh-eating disease�, which refers, primarily, to a form of invasive group A beta hemolytic streptococcal (GABHS) infection that leads to fascia and muscle necrosis. In 1999, the Canadian Paediatric Society issued a statement on the state of knowledge and management of children, and close contacts of persons with all-invasive GABHS disease (1). The present note is intended to deal specifically with necrotizing fasciitis (NF) by providing an update on the limited current state of knowledge, diagnosis and management. Surveillance to establish actual national rates and epidemiology of NF through the Canadian Paediatric Society is proposed.

Flesh-eating Disease A Note On Necrotizing Fasciitis

H Dele Davies — 2006-03-02 00:54:02 GMT

Flesh-eating disease: A note on necrotizing fasciitis H Dele Davies MD MSc, Child Health Research Unit, Alberta Children�s Hospital and Departments of Pediatrics, Microbiology and Infectious Diseases and Community Health Sciences, University of Calgary, Calgary, Alberta Paediatrics and Child Health May/June 2001, Volume 6, Number 5 There has been much media attention in the past few years to the condition dubbed �flesh-eating disease�, which refers, primarily, to a form of invasive group A beta hemolytic streptococcal (GABHS) infection that leads to fascia and muscle necrosis. In 1999, the Canadian Paediatric Society issued a statement on the state of knowledge and management of children, and close contacts of persons with all-invasive GABHS disease (1). The present note is intended to deal specifically with necrotizing fasciitis (NF) by providing an update on the limited current state of knowledge, diagnosis and management. Surveillance to establish actual national rates and epidemiology of NF through the Canadian Paediatric Society is proposed

Gas Gabgrene and Necrotizing Fasciitis SOA Textbook

Waldo E. Floyd III, M.D. & Betsy N. Perry, MD — 2009-11-15 00:54:02 GMT

Gas Gangrene and Necrotizing Fasciitis in the Upper Extremity

Floyd & Perry — 2007-07-01 00:54:02 GMT

Necrotizing soft-tissue infections encompass a wide variety of clinical syndromes resulting from introduction of various pathogens into injured or devitalized tissue. The extent of microbial involvement in such tissue may range from simple contamination, which results in self-limited bacterial proliferation with few, if any, clinical symptoms to overt and progressive local tissue necrosis, which, if untreated, may lead to septicemia and death. Early differentiation among these infections is not always possible, as there are overlapping classification criteria.
This chapter will provide an overview of necrotizing soft-tissue infections in the upper extremity focusing on gas gangrene, or clostridial myonecrosis, and necrotizing fasciitis to facilitate early diagnosis and optimal management of these lethal diseases.
Authors - Waldo E. Floyd III, M.D. Betsy N. Perry, MD Mercer University School of Medicine Emory University School of Medicine Macon, GA 31201

Necrotising Fasciitis

Hasham et al — 2006-05-07 00:54:02 GMT

BMJ 2005;330:830-833 (9 April), doi:10.1136/bmj.330.7495.830 Clinical review Necrotising fasciitis Saiidy Hasham, research registrar in plastic surgery1, Paolo Matteucci, specialist registrar in plastic surgery1, Paul R W Stanley, consultant plastic surgeon1, Nick B Hart, consultant plastic surgeon1 1 Department of Plastic Reconstructive and Hand Surgery, Castle Hill Hospital, Cottingham, East Yorkshire HU16 5JQ Correspondence to: S Hasham saiidyhasham@hotmail.com Necrotising fasciitis is a rare but life threatening condition that requires immediate action, but uncertainties still hamper prompt diagnosis and treatment

Necrotizing Fasciitis

Trent & Kirsner — 2006-02-28 00:54:02 GMT

Necrotizing Fasciitis from Wounds Posted 11/25/2002 Jennifer T. Trent, MD, Robert S. Kirsner, MD Abstract Necrotizing fasciitis (NF) is a rare, life-threatening infection resulting in necrosis of the skin, subcutaneous tissue, and fascia. Mortality rates have been noted as high as 73 percent. Certain conditions can predispose patients to NF, such as diabetes mellitus, immunosuppressive medications, and AIDS. Patients usually complain of excessive pain as well as constitutional symptoms. Cutaneous findings include diffuse redness and edema progressing to necrosis and hemorrhagic bullae. Because of this rapid progression, it is important to diagnose and treat NF quickly to decrease mortality. Treatment includes broad-spectrum antibiotic coverage, nutritional supplements, hemodynamic support, wound care, and prompt surgical debridement.

Necrotizing Fasciitis

Robert Swartz — 2006-03-02 00:54:02 GMT

E-Medicine 2005 Necrotizing Fasciitis Author: Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School Coauthor(s): Rajendra Kapila, MD, Associate Professor, Department of Medicine, UMDNJ, New Jersey Medical School Necrotizing fasciitis (NF) is an insidiously advancing soft tissue infection characterized by widespread fascial necrosis. A number of bacteria in isolation or as a polymicrobial infection can cause NF. The organisms most closely linked to NF are group A beta-hemolytic streptococci, though these bacteria may cause only a minority of the cases. Most cases are caused by other bacteria or different streptococcal serotypes. NF was first described in 1848. In 1920, Meleney identified 20 patients in China in whom hemolytic streptococcus was the sole organism. Wilson coined the term necrotizing fasciitis in 1952 and found no specific pathologic bacteria related to the disease. A few distinct NF syndromes should be recognized. The 3 most important are type I, or polymicrobial; type II, or group A streptococcal; and type III gas gangrene, or clostridial myonecrosis. A variant of NF type I is saltwater NF, in which an apparently minor skin wound is contaminated with saltwater containing a Vibrio species. NF may occur as a complication of a variety of surgical procedures, including cardiac catheterization (Federman, 2004). Familiarity with NF may facilitate earlier diagnosis and initiation of appropriate therapy.

Necrotizing Fasciitis

Brian Ostrow — 2006-03-02 00:54:02 GMT

Surgery in Africa Article Necrotizing Fasciitis While cellulitis and pyomyositis can be treated with reasonable success and low mortality rates, this is not the case for necrotizing soft tissue infections (NSTI). Here mortality rates range from 30-70% and have not decreased significantly despite modern therapy. (40) Reports from Singapore (41), India (42) and Oman (43) give a sense of the non-Western experience. NSTIs can be divided into two major categories: 1. Necrotizing fasciitis (NF) and 2. Gas gangrene. (44) Necrotizing fasciitis is further divided on the basis of clinical picture and microbiology into types I and II. (more)

Necrotizing Fasciitis

Trent et al — 2006-03-04 00:54:02 GMT

Necrotizing Fasciitis

Open Authorship — 2006-12-01 00:54:02 GMT

Definition Necrotizing fasciitis is a rare, often fulminant, rapidly progressive infectious process primarily involving the fascia and subcutaneous tissue. The pathophysiology involves the rapid spread of infection along the fascial planes, fascial necrosis and thrombosis of the subcutaneous blood vessels, leading to cutaneous gangrene. Approximately 500 to 1500 cases reported annually in the US. The most often associated comorbities are diabetes mellitus and peripheral vascular disease. It is most often peripheral, involving the lower limb. Delay to diagnosis is one of the most prominent predictors of mortality (along with diabetes). Prognosis for necrotizing fasciitis depends heavily on early recongnition and determination of the extent of necrosis in the preoperative planning. Clinical studies are lacking that compare different imaging modalities to the gold standard of fasciotomy. These series are typically small and only look at a handful of cases. Diagnostic Radiology/Musculoskeletal Imaging/Infection/Necrotizing fasciitis From Wikibooks, the open-content textbooks collection