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 in

volving necrosis of the SubQ tissue, superficial and deep fascia and sometimes the underlying muscles

Necrotizing Fasciitis

Predisposing factors: advanced age, trauma, DM, immunosuppre

ssion, 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, swelli

ng, 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 etiol

ogy ( 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)