Necrotizing Fasciitis: Case Reports and Literature Review 台北市立萬芳醫院 整形外科 張瓊文醫師

Necrotizing Fasciitis 1883 Fournier Rapidly progressive necrotizing infection of scrotum – Fournier’s gangrene 1924 Meleney – necrotizing fasciitis Bacterial synergism Necrotizing soft tissue infection: A rapidly progressive soft tissue infection involving necrosis of the SubQ tissue, superficial and deep fascia and sometimes the underlying muscles

Necrotizing Fasciitis Predisposing factors: advanced age, trauma, DM, immunosuppression, chronic systemic diseases ( HTN, ESRD, atherosclerosis ) Multiple etiology Bacteriology: polymicrobial

Necrotizing Fasciitis Key to successful treatment: Early diagnosis Broad-spectrum antibiotics Prompt and adequate surgical debridement and/or fasciotomy

Necrotizing Fasciitis Diagnosis: Traditional infection signs – reddness, swelling, local heat and tenderness Marked edema extending beyond erythema Bullae foremation(hemorrhagic) Crepitis Radiologic evidence of gas within tissues Rapidly progressive infection

Necrotizing Fasciitis Treatment: Prompt and adequate debridement and fasciotomy Modalities of Reconstruction: Primary closure Amputation ( BK or AK ) STSG Tissue expander Flap reconstruction

Necrotizing Fasciitis Need to be discussed: Bacteriology – varied with location and etiology ( esp. DM) Antibiotic evolution and the effect of cutting-edge antibiotics change the course of the diseases Adequate surgical debridement speed up the recovery and reduce hospital stay (average 2 weeks)