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

2. 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

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

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

5. 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

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

7. 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)