Necrotizing fasciitis surgery: Difference between revisions
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===Procedure=== | ===Procedure=== | ||
*Debridement of the tissue is the main surgical procedure.<ref name="pmid22196774">{{cite journal| author=Roje Z, Roje Z, Matić D, Librenjak D, Dokuzović S, Varvodić J| title=Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs. | journal=World J Emerg Surg | year= 2011 | volume= 6 | issue= 1 | pages= 46 | pmid=22196774 | doi=10.1186/1749-7922-6-46 | pmc=3310784 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22196774 }} </ref><ref name="pmid8916882">{{cite journal| author=Elliott DC, Kufera JA, Myers RA| title=Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. | journal=Ann Surg | year= 1996 | volume= 224 | issue= 5 | pages= 672-83 | pmid=8916882 | doi= | pmc=1235444 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8916882 }} </ref> | *Debridement of the tissue is the main surgical procedure.<ref name="pmid22196774">{{cite journal| author=Roje Z, Roje Z, Matić D, Librenjak D, Dokuzović S, Varvodić J| title=Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs. | journal=World J Emerg Surg | year= 2011 | volume= 6 | issue= 1 | pages= 46 | pmid=22196774 | doi=10.1186/1749-7922-6-46 | pmc=3310784 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22196774 }} </ref><ref name="pmid8916882">{{cite journal| author=Elliott DC, Kufera JA, Myers RA| title=Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. | journal=Ann Surg | year= 1996 | volume= 224 | issue= 5 | pages= 672-83 | pmid=8916882 | doi= | pmc=1235444 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8916882 }} </ref> | ||
*To achieve better surgical wound healing and less scarring, incisions are performed parallel to Langer's lines.<ref name="pmid25593960">{{cite journal| author=Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, Machairas A| title=Current concepts in the management of necrotizing fasciitis. | journal=Front Surg | year= 2014 | volume= 1 | issue= | pages= 36 | pmid=25593960 | doi=10.3389/fsurg.2014.00036 | pmc=4286984 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25593960 }} </ref> | |||
*Wide resection is performed with boundaries at least as wide as the rim of cellulitis until surrounding healthy bleeding tissue found. | *Wide resection is performed with boundaries at least as wide as the rim of cellulitis until surrounding healthy bleeding tissue found. | ||
*After drainage of pus and/or hemorrhagic fluid, ventricle incisions are made, keeping the wound open which allows drainage and removal of additional necrotic tissue. | |||
*Re-exploration and serial debridements, spaced 12 to 36 hours, are needed to control the infection. | *Re-exploration and serial debridements, spaced 12 to 36 hours, are needed to control the infection. | ||
*The extent and depth of debridement is so extensive that it may involve group of muscles which requires removal of all the muscles. | *The extent and depth of debridement is so extensive that it may involve group of muscles which requires removal of all the muscles. | ||
Revision as of 00:34, 12 September 2016
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Necrotizing fasciitis Microchapters |
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Risk calculators and risk factors for Necrotizing fasciitis surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]
Overview
Surgery
Surgery is the mainstay of treatment for necrotizing fasciitis.
- Indications include:[1]
- Patients displaying intense pain and skin color change such as edema and/or ecchymoses
- Signs of skin ischemia with blisters and bullae
- Altered mental status, hypotension, elevated band forms in the differential WBC count and metabolic acidosis.
- Immediate surgical referral remains the only method of reducing mortality and morbidity in necrotizing fasciitis patients.[2][3]
- As the patient's are cardiovascularly unstable, immediate resuscitation with intravenous fluids, colloids and inotropic agents are usually necessary.[4]
- Effects of analgesia can be measured by documenting pain score regularly.
- Stop the NSAID's on admission of patients.
Procedure
- Debridement of the tissue is the main surgical procedure.[2][5]
- To achieve better surgical wound healing and less scarring, incisions are performed parallel to Langer's lines.[1]
- Wide resection is performed with boundaries at least as wide as the rim of cellulitis until surrounding healthy bleeding tissue found.
- After drainage of pus and/or hemorrhagic fluid, ventricle incisions are made, keeping the wound open which allows drainage and removal of additional necrotic tissue.
- Re-exploration and serial debridements, spaced 12 to 36 hours, are needed to control the infection.
- The extent and depth of debridement is so extensive that it may involve group of muscles which requires removal of all the muscles.
Perineal, perianal or scrotal infection
- A temporary diverting colostomy should be considered to facilitate the decrease need for frequent change of dressings, protect the skin graft for reconstruction and wound hygiene.
- After scrotal resection, the testes are treated by placing them in pockets in the medial aspects of the thighs.
Amputation
Amputation is considered if the infection is rapidly spreading towards the trunk despite aggressive debridement or if the infection includes the joint.[6]
Images
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![Surgery of necrotizing fasciitis.The excision of the necrotic tissues should extend until healthy tissue is found, but should be limited to the edges of the infection.[1]](/images/e/e0/Surgery_NF.jpg)
Surgery of necrotizing fasciitis.The excision of the necrotic tissues should extend until healthy tissue is found, but should be limited to the edges of the infection.[1]
![Surgery of necrotizing fasciitis.The excision of the necrotic tissues should extend until healthy tissue is found, but should be limited to the edges of the infection.[1]](/index.php/File:Surgery_NF.jpg)
References
- ↑ 1.0 1.1 1.2 Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, Machairas A (2014). "Current concepts in the management of necrotizing fasciitis". Front Surg. 1: 36. doi:10.3389/fsurg.2014.00036. PMC 4286984. PMID 25593960.
- ↑ 2.0 2.1 Roje Z, Roje Z, Matić D, Librenjak D, Dokuzović S, Varvodić J (2011). "Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs". World J Emerg Surg. 6 (1): 46. doi:10.1186/1749-7922-6-46. PMC 3310784. PMID 22196774.
- ↑ Mok MY, Wong SY, Chan TM, Tang WM, Wong WS, Lau CS (2006). "Necrotizing fasciitis in rheumatic diseases". Lupus. 15 (6): 380–3. PMID 16830885.
- ↑ Baxter F, McChesney J (2000). "Severe group A streptococcal infection and streptococcal toxic shock syndrome". Can J Anaesth. 47 (11): 1129–40. doi:10.1007/BF03027968. PMID 11097546.
- ↑ Elliott DC, Kufera JA, Myers RA (1996). "Necrotizing soft tissue infections. Risk factors for mortality and strategies for management". Ann Surg. 224 (5): 672–83. PMC 1235444. PMID 8916882.
- ↑ Anaya DA, McMahon K, Nathens AB, Sullivan SR, Foy H, Bulger E (2005). "Predictors of mortality and limb loss in necrotizing soft tissue infections". Arch Surg. 140 (2): 151–7, discussion 158. doi:10.1001/archsurg.140.2.151. PMID 15723996.