Objective:To summarize the clinical characteristics and management experience of complications in patients with cervical necrotizing fasciitis （CNF） with or without descending necrotizing mediastinitis （DNM）, in order to provide a basis for optimizing diagnosis and treatment strategies. Methods:A retrospective analysis was conducted on the clinical data of 31 patients diagnosed with CNF and DNM at Shandong Provincial Hospital Affiliated to Shandong First Medical University between October 2019 and March 2024. A comprehensive evaluation was performed based on the patients' clinical characteristics, metagenomic next-generation sequencing （mNGS） pathogen detection results, imaging assessments, surgical interventions, management approaches for specific complications, and prognostic outcomes. Results:Among the 31 patients, 10 had severe diabetes mellitus. Etiological analysis was summarized as follows: 5 cases were odontogenic, 3 were of tonsillar origin, 3 were due to endogenous esophageal injury, 2 were due to exogenous cervical trauma, 2 originated from a congenital branchial cleft fistula, and 16 cases had an unknown etiology. Among them, 29 patients underwent surgery via an external cervical approach, 1 patient underwent surgery via an intraoral approach, and 1 patient received ultrasound-guided puncture and drainage therapy. Ultimately, 29 patients were cured and discharged （including 1 patient who experienced two instances of major neck vessel rupture and successfully underwent two interventional embolization procedures for hemostasis）; 2 patients died after failed rescue efforts due to concurrent sepsis and multiple organ dysfunction. The treatment success rate was 93%, and the mortality rate was 7%. In this cohort of CNF and DNM cases, only a minority had a clearly identified odontogenic cause; although the etiology was unknown in most cases, imaging consistently showed oropharyngeal lymph node necrosis, suggesting a possible pharyngeal origin of infection in adults. The mNGS pathogen profile was predominantly Gram-positive bacteria, accompanied by anaerobic bacilli and fungi. Conclusion:CNF and DNM are severe and rapidly progressive conditions that can lead to life-threatening complications within hours. Timely recognition can reduce unnecessary examinations and expedite treatment.
Humans ; Retrospective Studies ; Fasciitis, Necrotizing/therapy* ; Mediastinitis/complications* ; Neck/pathology* ; Male ; Female ; Middle Aged ; Adult ; Aged ; Prognosis

Necrotizing fasciitis (NF) is an aggressive soft-tissue infection involving the deep fascia and is characterized by extensive deterioration of the surrounding tissue. Immediate diagnosis and intensive treatment, including debridement and systemic antibiotics, represent the most important factors influencing the survival of NF patients. In this report, we present a case of NF in the abdomen due to an infection caused by a perforated small bowel after abdominal liposuction. It was successfully treated using negative-pressure wound therapy, in which a silicone sheet functioned as a barrier between the sponge and internal organs to protect the small bowel.
Abdomen ; Abdominal Wall* ; Anti-Bacterial Agents ; Debridement ; Diagnosis ; Fascia ; Fasciitis, Necrotizing* ; Humans ; Lipectomy ; Negative-Pressure Wound Therapy* ; Peritoneum ; Porifera ; Silicon* ; Silicones*

OBJECTIVETo study the application of VSD in the treatment of severe necrotizing fasciitis in extremities of patients.

METHODSEight patients, suffering from severe necrotizing fasciitis, who had been traditionally treated with iodophor-soaked gauze for 21 to 365 days in other hospitals, were transferred to our institute because of the nonhealing wounds and systemic toxic symptoms induced by infection, from January 2011 to August 2013. After admission, surgical debridement was performed timely, and the necrotic tissue was collected during the operation for pathological observation after HE staining. After the operation, VSD was started with negative pressure ranging from -100 to -80 kPa, and the furacilin solution (0.2 g/L) and oxygen (2 L/min) were continuously infused into the wound during the treatment. Surgical debridement was performed repeatedly according to the wound condition followed by change of VSD dressings to continue VSD treatment. The wounds were closed by suturing or with autologous skin grafts after being covered by fresh granulation tissue. The times of surgical debridement, times of change of VSD materials, wound healing status, and length of stay in our institute were recorded. All patients were followed up for a long time. Results HE staining showed that there were diffuse necrotic adipose and fibrous connective tissues in the necrotic tissue, and the normal tissue structure disappeared accompanied by significant infiltration of inflammatory cells. The number of surgical debridement was 2 to 10 (3.9 +/- 2.8) times. The number of VSD materials change was 2 to 10 (4.0 +/- 2.9) times. Wounds were closed by suturing and healed in two patients; wounds in the other six patients were partially sutured, their residual wounds were healed by autologous skin grafting. The length of stay in our institute was 20 to 49 (33 +/- 10) days. All patients were discharged after recovery. Patients were followed up for 2 to 24 months, and their wounds were found to be in good condition without ulceration or recurrence.

CONCLUSIONSVSD can effectively remove the necrotic tissues and exudates from the fascial spaces and promote proliferation of granulation tissue. Therefore it serves as an effective approach to the treatment of severe necrotizing fasciitis in extremities.

Debridement ; Drainage ; Extremities ; surgery ; Fasciitis, Necrotizing ; surgery ; Granulation Tissue ; Humans ; Negative-Pressure Wound Therapy ; Oxygen ; Pressure ; Skin ; Skin Transplantation ; Ulcer ; Vacuum

Necrotizing fasciitis (NF) is a rare and rapidly progressive disease involving the skin, subcutaneous tissue, and deep soft tissue. Although NF can occur any part of the body, the breast is an uncommon primary site for NF, and its occurrence in the breast during pregnancy has never previously been reported. Here, we report the case of a healthy 31-year-old pregnant woman who presented with NF of the left breast that was successfully treated with breast-conserving debridement and secondary wound closure using negative-pressure wound therapy.
Adult ; Breast* ; Debridement ; Fasciitis, Necrotizing* ; Female ; Humans ; Negative-Pressure Wound Therapy* ; Pregnancy ; Pregnant Women* ; Skin ; Subcutaneous Tissue ; Wounds and Injuries

In this article, we present two cases of femoral pseudoaneurysm (PA) at the femoral arterial puncture site followed by necrotizing fasciitis, which is rare but can be fatal when not managed appropriately. PA was revealed by lower-extremity angiography and color-flow Doppler ultrasonography. Hematoma removal, thrombolysis, and bleeder ligation with Gelfoam were repeatedly performed by a vascular surgeon. When necrotizing fasciitis developed, aggressive surgical drainage and creation of a viable wound bed for reconstruction were mandatory. We adopted a vacuum-assisted closure device (Kinetics Concepts International) as the standard treatment for complicated, serious, infected PA of the puncture site. Excellent clinical outcomes were obtained.
Aneurysm ; Aneurysm, False* ; Angiography ; Drainage ; Fasciitis ; Fasciitis, Necrotizing* ; Femoral Artery ; Gelatin Sponge, Absorbable ; Hematoma ; Ligation ; Negative-Pressure Wound Therapy ; Punctures* ; Ultrasonography, Doppler ; Wounds and Injuries

INTRODUCTIONSevere perianal sepsis is often difficult to manage after surgical debridement due to faecal contamination. Diversion of the faecal stream has been attempted with faecal pouches and rectal tubes, and in some cases, a diverting stoma is created. However, reversal of the stoma may be delayed due to prolonged sepsis and this is not without risks. Herein, we review the use of a flexible faecal management system in patients with severe perianal sepsis.

METHODSWe retrospectively evaluated 15 patients who made use of the ConvaTec Flexi-Seal® Fecal Management System (FMS) between 1 January 2007 and 31 December 2010. The demographics and comorbidities of the patients, as well as the treatment received, were recorded and reviewed.

RESULTSNone of the patients required the creation of a stoma to divert the faecal stream. Nursing requirements and wound care were found to be improved with the use of the Flexi-Seal® FMS (fewer changes were needed). No severe complications were observed in our series. Two deaths were encountered, but the cause of death was not directly due to the initial perianal sepsis. Overall, the wound healing rate was 80.0%, with one graft failure (11.1%).

CONCLUSIONThe use of the Flexi-Seal® FMS in patients with perianal sepsis following extensive debridement is feasible and can be considered before stoma creation.

Adult ; Aged ; Anti-Bacterial Agents ; Bacterial Proteins ; isolation & purification ; Catheters, Indwelling ; Debridement ; Enterococcus ; isolation & purification ; Fasciitis, Necrotizing ; microbiology ; surgery ; Feces ; Female ; Fournier Gangrene ; microbiology ; Hemolysin Proteins ; isolation & purification ; Humans ; Klebsiella ; isolation & purification ; Male ; Middle Aged ; Perineum ; microbiology ; Rectum ; microbiology ; Retrospective Studies ; Sepsis ; diagnosis ; drug therapy ; microbiology ; therapy ; Singapore ; Surgical Stomas ; Treatment Outcome ; Wound Healing

Adult ; Anti-Bacterial Agents ; therapeutic use ; Emergency Treatment ; methods ; Fasciitis, Necrotizing ; drug therapy ; surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Shock, Septic ; drug therapy ; surgery ; Vibrio Infections ; drug therapy ; surgery

Fasciitis, Necrotizing ; diagnosis ; etiology ; Hemorrhoids ; therapy ; Humans ; Male ; Middle Aged ; Sclerotherapy ; adverse effects

Varicella is a self-limited disease, but sometimes it may be associated with some serious life-threatening complications.Necrotizing fasciitis is a rare complication of varicella. This is a case of a 7-year-old girl with septic shock caused by necrotizing fasciitis as a complication of varicella. Swelling and pain in the left inguinal region and left axillary region were found five days after varicella. Then a high fever occurred followed by hypotension. Fluid infusion, vasopressor and antibiotics were administered. Group A beta-hemolytic Streptococcus was isolated from exudates from the wounds. The clinical symptoms markedly improved after surgical drainage and removal of the necrotic tissue. Both wounds were covered with skin grafts after healthy granulation tissue formed. Although there have been few reports of life-threatening necrotizing fasciitis following varicella in western countries, it is rare in China. Usually patients with varicella were admitted to pediatric or infectious disease department but not surgical departments; so that the clinicians should be aware that varicella may be complicated by life-threatening surgical infections. Necrotizing fasciitis should be suspected in patients of varicella who showed an increasing pain and swelling in any body areas associated with increasing fever and local erythema. Early identification, surgical drainage and debridement are essential for successful treatment of necrotizing fasciitis.
Chickenpox ; complications ; Child ; Fasciitis, Necrotizing ; diagnosis ; drug therapy ; etiology ; Female ; Humans ; Shock, Septic ; diagnosis ; drug therapy ; etiology

Necrotizing fasciitis is an invasive soft tissue infection that progresses rapidly. It rarely occurs in the craniocervical area but when it does, it can be fatal; an early diagnosis and treatment would be thus important. Patients with necrotizing fasciitis are treated with intravenous antibiotics after wide debridement of necrotic tissues and daily dressing with antibiotic solution. Since daily dressing is thought to be a bothering procedure to both patients and medical doctors, we applied negative pressure wound therapy on the necrotizing fasciitis wound after operation. Negative pressure wound therapy has been used broadly in the departments of plastic surgery, orthopedic surgery and urology but rarely in the department of otorhinolaryngology. After applying the negative pressure wound therapy, the wound was successfully healed. We hereby introduce the benefits of negative pressure treatment on necrotizing fasciitis patients.
Anti-Bacterial Agents ; Bandages ; Debridement ; Early Diagnosis ; Fasciitis, Necrotizing ; Humans ; Neck ; Negative-Pressure Wound Therapy ; Orthopedics ; Otolaryngology ; Soft Tissue Infections ; Surgery, Plastic ; Urology