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Introducción. La gangrena de Fournier es un proceso infeccioso progresivo que compromete piel, tejido celular subcutáneo, grasa y fascia subyacente, con una incidencia de 1,6 pacientes por cada 100.000 personas/año. Se considera una urgencia quirúrgica, que requiere de manejo oportuno, ya que puede llegar a ser fatal, con una tasa de mortalidad del 20 al 35 %, que es más alta en hombres, en la tercera década de la vida y en pacientes inmunocomprometidos. Caso clínico. Se presenta el caso clínico de un paciente masculino de 44 años de edad, quien cursó con gangrena de Fournier secundaria a una espina de pescado de 5 cm de largo, incrustada en la unión anorrectal. Resultados. El paciente fue manejado por urología y cirugía general, requirió hospitalización en la Unidad de Cuidados Intensivos y curaciones por parte de terapia enterostomal, con resultados satisfactorios. Conclusiones. Sus posibles causas son múltiples y en ocasiones puede ser desencadenada por un factor externo, como un cuerpo extraño. Uno de los factores predisponentes es la obesidad. El diagnóstico oportuno y un tratamiento con intervención multidisciplinaria mejoran la sobrevida y la calidad de vida de los pacientes.
Introduction. Fournier's gangrene is a progressive infectious process that involves skin, subcutaneous tissue, fat and underlying fascia, with an incidence of 1.6 per 100,000 people/year. It is considered a surgical emergency, which requires timely management since it can be fatal, with a mortality rate of 20 to 35%, which is higher in men, in the third decade of life and in immunocompromised patients. Clinical case. Clinical case. A 44-year-old male patient is presented with Fournier's gangrene secondary to a 5 cm long fishbone embedded in the anorectal junction. Results. The patient was managed by urology and general surgery, requiring hospitalization in the ICU and treated by enterostomal therapy with satisfactory results. Conclusions. Its possible causes are multiple and sometimes it can be triggered by an external factor, such as a foreign body. One of the predisposing factors is obesity. Timely diagnosis and treatment with multidisciplinary intervention improve survival and quality of life of patients
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Humanos , Sistema Urogenital , Gangrena de Fournier , Recto , Fascitis Necrotizante , CelulitisRESUMEN
RESUMEN La fascitis nodular es una neoplasia infrecuente y benigna que puede presentarse en los tejidos blandos de cualquier región del cuerpo y requerir tratamiento quirúrgico. Se describe aquí el caso de una mujer de 41 años con un tumor lateral de cuello que creció hasta 74,7 por 32,5 mm durante dos años. Bajo anestesia general se realizó la resección completa del tumor. El informe patológico informó una proliferación de miofibroblastos, compatible con fascitis nodular. La paciente evolucionó con un síndrome de Claude Bernard Horner homolateral, sin complicaciones locales y con una leve debilidad del brazo homolateral que recuperó luego de 60 días con kinesioterapia. Esta entidad debería ser considerada entre los diagnósticos diferenciales de un tumor lateral de cuello.
ABSTRACT Nodular fasciitis is a rare and benign neoplasm of the soft tissues that can occur in any region of the body and require surgical treatment. We report the case of a 41-year-old female patient with a lateral neck tumor which reached a size of 74.7 × 32.5 mm after two years. The tumor was completely removed under general anesthesia. The pathological examination reported proliferation of myofibroblasts, suggestive of nodular fasciitis. The patient evolved homolateral Claude Bernard Syndrome, without local complications and mild weakness of the ipsilateral arm which improved after 60 days with kinesiotherapy. This condition should be considered among the differential diagnoses of lateral neck tumors.
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Introducción. La perforación del recto por trauma cerrado es poco frecuente y se asocia a fracturas pélvicas. En pacientes con perforaciones de recto no traumáticas se ha reportado fascitis necrosante en miembros inferiores, en la mayoría de los casos asociada a alta mortalidad. Caso clínico. Hombre de 36 años con trauma cerrado abdomino-pélvico y perforación de recto inferior, quien recibió manejo quirúrgico mediante derivación intestinal y fijación pélvica. Evolucionó con hematoma escrotal sobreinfectado, inestabilidad hemodinámica, signos de fascitis necrosante y choque séptico 4 días posterior a su ingreso. Resultados. Se tomó muestra para cultivo del hematoma escrotal que reportó E. coli. La patología del desbridamiento escrotal informó necrosis de coagulación en toda la muestra. Conclusión. El tacto rectal debe realizarse siempre ante la presencia de enfisema subcutáneo al examen físico o en la tomografía, para un diagnóstico temprano y manejo quirúrgico multidisciplinario oportuno, según el caso. La presencia de enfisema subcutáneo debe aumentar la sospecha de perforación de recto. Hay pocos reportes de fascitis secundaria a perforación de recto por trauma cerrado, por lo que no se conoce con precisión la mortalidad asociada.
Introduction. Rectal perforation due to blunt trauma is rare and associated with pelvic fractures. Signs of necrotizing fasciitis in lower limbs have been reported in non-traumatic rectal perforations, in most cases associated with high mortality. Case report. A 36-year-old man presents blunt abdomino-pelvic trauma and perforation of the lower rectum. Surgical management by intestinal diversion and pelvic fixation is performed. 4 days after admission, evolves with over-infected scrotal hematoma, hemodynamic instability, signs of necrotizing fasciitis and septic shock. Results. A sample for culture was taken from a scrotal hematoma that reported E. coli. Pathology of scrotal debridement reported coagulation necrosis in the entire specimen. Discussion. Digital rectal examination should always be performed in the presence of subcutaneous emphysema on physical examination or CT scan for early and multidisciplinary diagnosis and surgical management as appropriate. Conclusion. The presence of subcutaneous emphysema should raise the suspicion of rectal perforation. There are few reports of rectal perforation due to blunt trauma and fasciitis, so the associated mortality is not precisely known.
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Humanos , Recto , Gangrena de Fournier , Fascitis , Heridas y Lesiones , Perforación IntestinalRESUMEN
Necrotizing fasciitis of the breast is a rare entity, with very few cases reported in the literature. It is rapidly progressive and can lead to sepsis and multi-organ failure without prompt medical and surgical management. In this particular case, a 71-year-old diabetic female presented with primary necrotizing fasciitis affecting her right breast. Upon arrival, she was in septic shock, exhibiting noticeable breast necrosis and nipple discharge. Immediate resuscitation was administered, followed by a muscle-sparing mastectomy. A vacuum-assisted closure (VAC) device dressing was applied during the procedure, and the patient was subsequently managed in intensive care postoperatively. As of now, the patient is free from the disease, and her wound has completely healed.
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Objective@#To investigate the clinical characteristics, diagnosis, treatment, and prognosis of descending necrotizing mediastinitis (DNM) to provide a reference for the early diagnosis and timely treatment of DNM.@*Methods@#Data on DNM in China was electronically retrieved from the core databases and comprehensively reviewed from June 2012 to June 2023. The infection, pathogenic microorganisms, main symptoms, comorbidities and treatment methods of DNM were analyzed.@*Results@#The data of a total of 781 DNM patients, with an average age of (52.97 ± 5.64) years, were retrieved, including 554 males and 227 females. Odontogenic source, tonsillitis, pharyngeal abscess, sialoadenitis, upper respiratory tract infection, foreign body injury, or iatrogenic traumatic procedures are common causes. Among these, odontogenic infection is the most common source. Streptococcus sp. (n = 217) and Staphylococcus sp. (n = 82) were most isolated, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa (equally n = 59). A total of 69.4% (542/781) of DNM patients recruited in this study were discovered to have various comorbidities, and more than one-third of these patients (n = 185) had diabetes. Of the broad antibiotics, carbapenem was most frequently used as treatment, and vancomycin was the most frequently coadministered. The mediastinal drainage approach varies widely, and the optimal regimen is still unknown. Seventy-two patients were treated with video-assisted thoracoscopic/mediastinoscopic surgical drainage, 22 patients were treated with percutaneous catheter drainage, 30 underwent the transcervical approach, and 40 underwent thoracotomy. A total of 617 patients who were selected underwent the appropriate combined operation for surgical drainage according to the specific location of the infected focus. The overall mortality rate of all 781 DNM patients included was 11.2%.@*Conclusion@#The most effective diagnosis and treatment of DNM is a high degree of clinical vigilance followed by prompt and adequate drainage with intensive care, including hemodynamic monitoring, nutritional support, computer tomographic scanning repeated as necessary, and combined use of systemic antibiotics.
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Objective To explore the application value of Three-Dimensional rectal cavity ultrasound combined with contrast agent imaging in necrotizing fasciitis of the anal region.Methods Before surgery,standard three-dimensional rectal cavity ultrasound examinations(referred to as the conventional group)and contrast agent imaging examinations(referred to as the imaging group)were conducted for 40 patients clinically diagnosed with anal region necrotizing fasciitis.Separate observations were made for the primary lesion,as well as for the depth and superficial necrosis of the fascia,and injuries to the anal sphincter muscle.Comparative analysis with surgical results was undertaken to assess the diagnostic sensitivity of both the conventional and imaging groups.Results In comparing the conventional group with the imaging group,the rates of primary lesion visibility rose significantly from 70%to 97.5%,deep fascial necrosis visibility increased from 50%to 88.8%,superficial fascia visibility improved from 70%to 100%,and the visibility of anal sphincter muscle injury escalated from 62.5%to 97.2%,all demonstrating statistical significance at P<0.05.Conclusions Three-dimensional rectal cavity ultrasound combined with contrast agent imaging exhibits significantly enhanced accuracy in identifying primary lesions associated with perianal necrotizing fasciitis,as well as the necrosis affecting deep and superficial fascia,in contrast to conventional three-dimensional rectal cavity ultrasound.This advancement offers more precise guidance for clinicians in devising surgical plans,thereby augmenting the success rate of surgical interventions.
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BACKGROUND:At present,the treatment methods for necrotizing fasciitis mostly use negative pressure sealing suction after thorough debridement.This method requires repeated debridement to completely remove necrotic infected tissue,causing serious physical and economic burdens to patients. OBJECTIVE:To introduce a rare clinical case of calf compartment syndrome caused by diabetic foot necrotizing fasciitis,and summarize the clinical experience of using antibiotic-loaded bone cement for treatment and comprehensive management. METHODS:A total of 6 patients with calf compartment syndrome caused by diabetic necrotizing fasciitis admitted to Wuxi 9th Affiliated Hospital of Soochow University from August 2017 to August 2020 were selected,including 5 males and 1 female with an average age of 54 years.During the perioperative period,the patients'general condition was evaluated and systemic nutritional support treatment was given.In the first stage,all patients received complete debridement to control infection,antibiotic-loaded bone cement packing,and negative pressure sealed drainage.In the second stage,bone cement was removed and wound repair was performed.The wound healing,as well as the occurrence of redness,swelling,and exudation was observed during the follow-up. RESULTS AND CONCLUSION:(1)The wounds of four patients were fresh after twice antibiotic-loaded bone cement packing,and the membrane formation was good,and one patient was good after three times of antibiotic-loaded bone cement packing,and the wounds of all five patients healed well after the second stage of skin grafting.Due to the difficulty in maintaining intraoperative blood pressure and infection in all four compartments of the lower leg,a patient underwent emergency knee amputation.Meanwhile,the stump wound was placed with antibiotic-loaded bone cement.The wound was closed directly after the secondary bone cement was removed,and the wound healed in the first stage.(2)The six patients were followed up for 6-24 months after discharge.At the last follow-up,all six patients had good wound healing and no symptoms such as redness,swelling,and exudation.The quality of life of the patients was significantly improved,and all of them were satisfied with the curative effect.(3)The occurrence of calf compartment syndrome should be vigilant when diabetic foot necrotizing fasciitis is highly suspected.Early diagnosis and timely incision decompression are of great importance.Besides,the application of antibiotic-loaded bone cement in the treatment of calf compartment syndrome caused by diabetic necrotizing fasciitis has a good short-term effect.
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Scrotal mass is a common problem in the outpatient department of urology, accounting for 1% of all emergency patients. The diagnosis of scrotal masses is challenging due to the overlapping symptoms and signs of various scotal masses. Failure to correctly identify and treat scrotal masses, such as testicular torsion, testicular cancer, varicocele, and hydrocele, may lead to infertility, testicular loss, or even death. Misdiagnosis or missed diagnosis of scrotal masses may result in infertility, testicular loss, or even death. Therefore, we must maintain a high degree of vigilance and accurately identify scrotal masses that may affect life and testicular function. A full understanding of the manifestations and differences of various scrotal masses can help clinicians make accurate diagnoses and provide optimal treatment plans. The most critical aspect is to exclude emergency situations that may endanger life or testicular function, such as testicular torsion, testicular cancer, and necrotizing fasciitis, which require immediate medical attention. Scrotal ultrasonography is the best method for distinguishing scrotal masses based on their origin. Magnetic resonance imaging is the best tool for diagnosing scrotal hematoma. However, good clinical judgment and decision-making are still the most important factors for successful treatment of scrotal masses. The purpose of this article is to describe correct evaluation methods for scrotal masses and identify potential conditions that may threaten testicular survival, enabling accurate pathological diagnosis, evaluation, and treatment plans for each scrotal mass.
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Objective:To explore the clinical efficacy of Kinesio taping combined with extracorporeal shock wave and the plantar pressure evaluation in the treatment of plantar fasciitis. Method:A total of 67 patients with unilateral plantar fasciitis were randomly divided into the control group(ESWT group)and the experimental group(KT combined group).The patients in the two groups were given the same health education and extracorporeal shock wave treatment(ESWT),and the experimental group was treated with Kinesio taping(KT).The pain and functional activity were evaluated by pain visual analogue scale and AOFAS ankle and hind-foot function scale;The insole plantar pressure measuring system was used to mea-sure the peak pressure values of each plantar regions.The clinical efficacy and plantar pressure of the affected side were compared before treatment,the 3rd week of treatment and 5th week of treatment. Result:There was no significant difference in various indcators of the measurements between the two groups before treatment(P＞0.05).The score of pain rating,functional activity scale score and plantar pressure of pa-tients in both groups were significantly improved at the 3rd week and the 5th week of treatment(P＜0.05),com-pared with those before treatment.At the 3rd week of treatment,there was no significant difference between the two groups in pain degree and functional activity scale score(P＞0.05),but there was statistical difference in plantar pressure analysis(P＜0.05).The peak force weight ratio of the medial heel in the KT combined group was significantly greater than that in the control group.At the 5th week of treatment,there were statisti-cally significant differences between the two groups in the score of pain rating,functional activity scale score and plantar pressure(P＜0.05).The KT combined treatment group was significantly better than the control group in the pain improvement and functional activity,and the weight bearing of the middle foot and hind foot was also significantly higher than the control group. Conclusion:Compared with the simple extracorporeal shock wave therapy,the combination of KT therapy can better relieve pain,improve the function of hind foot,correct abnormal foot weight bearing,and improve the gait of patients.
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ABSTRACT Streptococcus agalactiae or Group B Streptococcus (GBS) infections are commonly associated with infections in neonates and pregnant women. However, there has been a rising incidence in nonpregnant adults. The risk of GBS infection in nonpregnant adults is increased for patients of advanced age and those with underlying medical conditions such as diabetes mellitus and cancer. We present a 77-year-old female with type-2 diabetes mellitus, hypertension, and bilateral foot ulcers that presented in probable septic shock with necrotic foot ulcers and necrotizing fasciitis and underwent bilateral lower limb amputations. The patient fulfilled the Streptococcal Toxic Shock Syndrome (STSS) criteria as defined by The Working Group on Severe Streptococcal Infections. These criteria were created for group A Streptococcus (Streptococcus pyogenes). Our patient fulfilled the Working Group's criteria, except that the blood culture was positive for group B Streptococcus (Streptococcus agalactiae). Numerous studies demonstrate the importance of early detection and antibiotic treatment for GBS infections in general and early surgical management for necrotizing soft tissue infections (NSTIs) such as necrotizing fasciitis.
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Introducción: La fascitis necrotizante es un cuadro muy grave causado por una infección bacteriana de la piel y de tejidos blandos subcutáneos, cuya evolución es hacia la destrucción y necrosis de los tejidos en un corto espacio de tiempo; el lupus eritematoso sistémico es una enfermedad autoinmune de causa desconocida que quienes la padecen tienen una mayor probabilidad de contraer infecciones debido al mal funcionamiento del sistema inmunológico y/o los efectos secundarios causados por los medicamentos. Objetivo: Observar la importancia de un tratamiento rápido y eficaz de la fascitis necrotizante en un paciente con lupus eritematoso sistémico y esteatohepatitis no alcohólica. Presentación de caso: Se presentó el caso clínico de un paciente de 30 años con diagnóstico de lupus eritematoso sistémico que desarrolló de forma concomitante de fascitis necrotizante y esteatohepatitis no alcohólica. A pesar de un tratamiento adecuado, el paciente fue agresivo. Tuvo una estadía hospitalaria de 83 días, con una evolución desfavorable que conllevó a la muerte(AU)
Introduction: Necrotizing fasciitis is a very serious condition caused by a bacterial infection of the skin and subcutaneous soft tissues, whose evolution is towards the destruction and necrosis of the tissues in a short space of time; Systemic lupus erythematosus is an autoimmune disease of unknown cause that sufferers are more likely to contract infections due to poor immune system function and/or side effects caused by medications. Objective: To observe the importance of rapid and effective treatment of necrotizing fasciitis in a patient with systemic lupus erythematosus and non-alcoholic steatohepatitis. Case report: We report the clinical case of a 30-year-old patient diagnosed with systemic lupus erythematosus who concomitantly developed necrotizing fasciitis and nonalcoholic steatohepatitis. Despite adequate treatment, the patient was aggressive. The patient had a hospital stay of 83 days, with an unfavorable evolution that led to his death(AU)
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Humanos , Masculino , Adulto , Fascitis Necrotizante/mortalidad , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Lupus Eritematoso Sistémico/etiologíaRESUMEN
La fascitis necrosante es una enfermedad rara y potencialmente mortal, que se produce por una infección grave que se disemina desde las fascias superficiales destruyendo el tejido celular subcutáneo y la piel suprayacente. Las formas perioculares de la enfermedad son aún más raras y pueden tener graves consecuencias para el paciente. El objetivo de este estudio fue contrastar los hallazgos clínicos y los resultados terapéuticos en una serie de cuatro casos diagnosticados en el Centro Oftalmológico de Holguín en el curso de cinco años. Entre 2017 y 2022 se diagnosticaron cuatro pacientes con formas perioculares de fascitis necrosante en el Centro Oftalmológico de Holguín. Dos pacientes tuvieron antecedentes de trauma menor. El dolor predominó entre los síntomas locales. Se identificaron dos patrones de lesiones: bilateral con ulceración y afectación de la región palpebral superior y unilateral con extensión en ambos párpados y apariencia oscura de la piel. Los pacientes evolucionaron a la gravedad con deterioro del estado general. El desbridamiento del tejido necrótico y el tratamiento con antibióticos de amplio espectro permitieron detener el progreso de la enfermedad, aunque quedaron secuelas anatómicas y funcionales. Un paciente falleció como consecuencia de una leucemia diagnosticada durante su ingreso. El reconocimiento temprano de la fascitis necrosante periocular y su inmediato tratamiento es indispensable para garantizar resultados óptimos y la supervivencia del paciente. Las formas perioculares pueden tener apariencia clínica diversa, lo que debe ser tenido en cuenta ante la sospecha de este cuadro, sobre todo por la similitud inicial con la celulitis preseptal(AU)
Necrotizing fasciitis is a rare and potentially fatal disease caused by a severe infection that spreads from the superficial fasciae destroying the subcutaneous cellular tissue and overlying skin. Periocular forms of the disease are even rarer and can have serious consequences for the patient. The aim of this study was to contrast clinical findings and therapeutic outcomes in a series of four cases diagnosed at the Holguin Ophthalmology Center over the course of five years. Between 2017 and 2022, four patients with periocular forms of necrotizing fasciitis were diagnosed at the Holguín Ophthalmologic Center. Two patients had a history of minor trauma. Pain predominated among the local symptoms. Two patterns of lesions were identified: bilateral with ulceration and involvement of the upper palpebral region and unilateral with extension in both eyelids and dark appearance of the skin. Patients progressed to severity with deterioration of general condition. Debridement of necrotic tissue and treatment with broad-spectrum antibiotics halted disease progression, although anatomical and functional sequelae remained. One patient died as a result of leukemia diagnosed during his admission. Early recognition of periocular necrotizing fasciitis and its immediate treatment is essential to ensure optimal outcome and patient survival. Periocular forms can have different clinical appearances, which should be taken into account when suspecting this condition, especially due to the initial similarity with preseptal cellulitis(AU)
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Humanos , Femenino , Persona de Mediana Edad , Anciano , Fascitis Necrotizante/epidemiología , Desbridamiento/métodosRESUMEN
Introduction: Fournier's gangrene is characterized by tissue necrosis, which requires treatment employing debridement and antibiotics with wounds of varying sizes. The objective is to standardize the surgical techniques of reconstructions with flaps used to treat wounds after Fournier's gangrene. Method: A study was conducted by searching the PubMed/Medline, SciELO, and LILACS databases. Results: In wounds with skin loss of 25% to 50%, a local advancement cutaneous flap or a pudendal flap from the thigh was used; in wounds, greater than 50%, a superomedial thigh flap or myocutaneous flap from the gracilis muscle was used, with the aim of to enable proper reconstruction. Conclusion: Advancement and pudendal thigh flaps were used for wounds with up to 50% loss of scrotal skin substance, while the myocutaneous gracilis flap and supero-medial flap of the thigh were indicated for wounds with more than 50% of the total scrotal surface affected, after Fournier gangrene.
Introdução: Gangrena de Fournier é caracterizada por necrose tecidual, que necessita de tratamento por meio de desbridamento e antibióticos, com feridas de dimensões variadas. O objetivo é padronizar as técnicas cirúrgicas de reconstruções com retalhos utilizadas no tratamento das feridas após gangrena de Fournier. Método: Realizou-se estudo por meio da busca nas bases de dados PubMed/Medline, SciELO e LILACS. Resultados: Nas feridas com perdas cutâneas de 25% a 50%, foram utilizados retalho cutâneo local de avanço ou retalho pudendo da coxa, nas maiores de 50% foram necessárias as confecções do retalho superomedial da coxa ou retalho miocutâneo do músculo grácil, com intuito de possibilitar a reconstrução adequada. Conclusão: Os retalhos de avanço e pudendo da coxa foram utilizados para feridas com perda de substância cutânea escrotal de até 50%, enquanto os retalhos miocutâneo de músculo grácil e superomedial da coxa foram indicados para as feridas com mais de 50% da superfície escrotal total acometida, após gangrena de Fournier.
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Background: Necrotizing fasciitis (NF) is a state of infection promptly intensifying the destruction of skin with underlying tissue leading to permanent infirmity and high mortality irrespective of good parenteral drug coverage and contentious surgical handling. NF normally begins as a confined infective focus that initially presents as cellulitis later rapidly progresses to large areas of infection which disproportionate to pain. Aims and Objectives: The primary aim of this study is to determine the incidence and management methods of NF in tertiary health-care center of western Odisha. Materials and Methods: A retrospective review of medical records of patients diagnosed with NF presenting to department of general surgery, Veer Surendra Sai Institute of Medical Sciences and Research Burla, from March, 2020 to February, 2022 was performed. Various information such as patient’s demographics, type of presentation at the time of admission, age group affected, body parts affected, mode of injury, and microbiological status were collected in a predesigned format for analysis. Data were presented in number and percentage. Results: A cumulative of 96 cases with clinical features of NF was reviewed. The median age group range was 31–40 years. Nearly 94.7% cases had significant underlying comorbidities. Extremities were most commonly affected part. About 82.2% cases had undergone surgical debridement, 13.5% cases fasciotomy, and 4.2% cases skin grafting. Most common mode of injury is trivial injury. Group A Streptococcus is most common cause of organism. Almost 78.3% cases were healed. Conclusions: NF can induce upscaled morbidity and mortality if left undetected and untreated in primordial stages. The medics, paramedics, and specialists including surgeons need to have a high degree of intuition to diagnose NF at its beginning stages and thus precisely put resuscitative efforts, plan for debridement, and need for any urgent referral.
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Background: Necrotizing fasciitis (NF) is a severe form of soft tissue infection, early diagnosis, and surgical intervention are direct factors in mortality, it may arise from many infectious aetiologies, at our hospital in Mexico city, it is not uncommon that hand infection patients progress to NF, that in many cases its recognition and treatment may also be delayed, resulting in fatal outcomes. Wong et al in 2004 introduced a laboratory risk indicator for necrotizing fasciitis (LRINEC score) that utilizes common laboratory values of patients with clinical infection and stratifies them by their risk of developing NF, so the aim of our study was to validate this tool in Mexican population. Methods: We reviewed all patients with an initial diagnosis of hand infection admitted at the emergency department of our hospital in Mexico City, from April 2020 to March 2022 and examined the LRINEC score at admission, post-debridement, and at the end of the hospitalization to evaluate its usefulness in our population. Results: The LRINEC score at cut-off ?6 reported sensitivity for the diagnosis of NF of 35.71% (95% CI 12.76-64.86%), specificity of 100% (95% CI 78.2-100%), positive predictive value of 100% (95% CI 71-100%), and negative predictive value of 62.5% (95% CI 53.01-71.12%). Conclusions: The LRINEC score is a useful tool to distinguish NF from other soft tissue infections, but it is not helpful for early recognition of NF alone, LRINEC score could predict worse hospital outcomes in patients with NF and identify the high-risk patients.
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Background: Necrotizing fasciitis (NF) is a severe form of soft tissue infection, early diagnosis, and surgical intervention are direct factors in mortality, it may arise from many infectious aetiologies, at our hospital in Mexico city, it is not uncommon that hand infection patients progress to NF, that in many cases its recognition and treatment may also be delayed, resulting in fatal outcomes. Wong et al in 2004 introduced a laboratory risk indicator for necrotizing fasciitis (LRINEC score) that utilizes common laboratory values of patients with clinical infection and stratifies them by their risk of developing NF, so the aim of our study was to validate this tool in Mexican population. Methods: We reviewed all patients with an initial diagnosis of hand infection admitted at the emergency department of our hospital in Mexico City, from April 2020 to March 2022 and examined the LRINEC score at admission, post-debridement, and at the end of the hospitalization to evaluate its usefulness in our population. Results: The LRINEC score at cut-off ?6 reported sensitivity for the diagnosis of NF of 35.71% (95% CI 12.76-64.86%), specificity of 100% (95% CI 78.2-100%), positive predictive value of 100% (95% CI 71-100%), and negative predictive value of 62.5% (95% CI 53.01-71.12%). Conclusions: The LRINEC score is a useful tool to distinguish NF from other soft tissue infections, but it is not helpful for early recognition of NF alone, LRINEC score could predict worse hospital outcomes in patients with NF and identify the high-risk patients.
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Background: Plantar fasciitis described as the inflammation of planter fascia, particularly hampering an individual’s daily living activities related to ankle and foot that impact on quality of life. The study aimed to identify the association between BMI and planter fasciitis among hospital staff in a selected hospital in Dhaka city. Methods: A descriptive cross-sectional study. Results: Mean±SD age of the respondents were 29.03±6.56 years. Among the hospital staff, the majority of the respondents were nurses 31.25%, 13.02% respondents were physician and 2.07% of respondents were physiotherapists, others were pharmacist, lab technician, administration staff, cleaner, security, information technologists and officers from the maintenance department of selected hospital. According to BMI scale the 65% were normal weight, 23% were overweight and only 12% were obese. In this study respondents who have only two family members, have strong relationships with BMI (p<0.00). Besides, the duration of work has a slightly significant relation with BMI (p<0.03) and BMI has a strong impact on level of pain (p<0.01) among respondents. Conclusions: The recommendation for risk variables that have a strong correlation with plantar fasciitis is the working status, duration, and BMI.
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SUMMARY: Cervical necrotizing fasciitis (NF) is a rare complication of oral cavity infection with high morbi-mortality. Given its low prevalence, adequately reporting cases of NF, its therapeutic management, and associated morphofunctional modifications to the clinical and scientific community is pivotal. To that end, we herein describe a case of cervical NF in a 60-year-old patient with comorbidities and patient presented large, painful cervical swelling associated with a necrotic ulcer lesion in the anterior neck region. Intraoral examination indicated a periodontal abscess in the right mandibular area, while computed tomography indicated the lesion's extension from the right mandibular to the submandibular region. Following empirical intravenous antibiotic treatment, a broad surgical debridement was performed, and the foci of oral infection were removed. Debridement revealed communication between deep and superficial anatomical regions in the submandibular area, where we subsequently placed a Penrose drain. Biopsies showing acute inflammatory infiltrate associated with necrotic and hemorrhagic regions confirmed the diagnosis of NF. When an antibiogram revealed resistance to the empirical treatment, the antibiotic scheme was replaced with an adequate alternative. After a second debridement, we closed the defect with fascio-mucocutaneous advancement flaps with a lateral base while maintaining suction drainage. Having reacted positively, the patient was discharged 10 days after the operation. Despite an extensive morphofunctional change generated in the treated area, the patient showed no difficulties with breathing, phonation, swallowing, or mobilizing the area during control sessions. Altogether, this report contributes to the highly limited literature describing morphological aspects that can facilitate or delay the spread of infection or the morphofunctional disorders associated with the size and depth of surgical interventions for cervical NF, information that is relevant for the comprehensive, long-term prognosis of the treatment of NF.
La fascitis necrosante (FN) cervical es una rara complicación de una infección proveniente de la cavidad bucal asociada a una alta morbimortalidad. Por lo anterior, es fundamental informar a la comunidad clínica y científica los casos de FN, su manejo terapéutico y las modificaciones morfofuncionales asociadas. Se describe un caso de FN cervical en una paciente de 60 años quien presentó una gran tumefacción dolorosa asociada a una lesión ulcerosa necrótica en la región anterior del cuello. El examen intraoral mostró un absceso periodontal en el área mandibular derecha y la tomografía computarizada mostró la extensión de la lesión hacia la región submandibular. Tras el tratamiento antibiótico empírico, se realizó un desbridamiento quirúrgico extenso y se extirparon los focos de infección oral. El desbridamiento reveló comunicación entre las regiones anatómicas profundas y superficiales del área submandibular, donde se colocó un drenaje Penrose. Las biopsias mostraron un infiltrado inflamatorio agudo asociado con regiones necróticas y hemorrágicas, confirmando el diagnóstico de FN. El antibiograma reveló resistencia al tratamiento empírico, por lo que el esquema antibiótico se sustituyó. Tras un segundo desbridamiento, se cerró el defecto con colgajos de avance fascio-mucocutáneos de base lateral manteniendo drenaje aspirativo. El positivo progreso del paciente permitió su alta 10 días después. Aun cuando se generó una gran modificación morfofuncional en el área tratada, la paciente no presentó dificultades para respirar, hablar, deglutir o movilizar el área cervical intervenida durante las sesiones de control. Este informe contribuye a la limitada literatura que describe los aspectos morfológicos que pueden facilitar o retrasar la propagación de la FN y las consecuencias asociadas a los trastornos morfofuncionales provocadas por el tamaño y profundidad de las intervenciones quirúrgicas requeridas por la FN, información relevante para el pronóstico integral a largo plazo del tratamiento de la FN.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Fascitis Necrotizante/cirugía , Absceso Periodontal/complicaciones , Resultado del Tratamiento , Fascitis Necrotizante/etiología , Fascitis Necrotizante/microbiología , Fascitis Necrotizante/patología , Recuperación de la Función , Desbridamiento , Cuello/cirugía , Cuello/patologíaRESUMEN
Background: Plantar fasciitis was initially thought to be an acute inflammatory disease, but histology findings show that it is a chronic degenerative process leading to pain at the calcaneal insertion without any inflammation. The diagnosis of plantar fasciitis is mainly based on clinical symptoms, like heel pain and tightness, and diagnostic imaging is not routinely required. Injection of autologous blood can help stimulate a healing response in chronic tendon disorders. Methods: Radiological imaging of the affected foot in lateral view will be taken. 30 patients will be treated with 2 ml of autologous blood with 1 ml lidocaine and another 30 patients with 2 ml of triamcinolone acetonide with 1 ml lidocaine. The main outcomes measured are subjective based on the visual analog scale done pre-injection, 2 weeks, 4 weeks and 12 weeks post injection. Final outcome was measured based on the pain and activity level at 3 months. Results: The corticosteroid group showed an early sharp and then more gradual improvement in pain scores, but autologous blood group had a steady gradual drop in pain. Conclusions: Autologous whole blood and corticosteroid local injection can both be considered as effective methods in the treatment of chronic plantar fasciitis.
RESUMEN
Introduction: Plantar fasciitis is a pathological condition whose etiology is multifactorial. It constitutes a major bulk of patients attending our outpatient department. Some of the risk factors involved are sport or physical exercise, being overweight, age, gender, prolonged standing, increased subtalar pronation accompanying pes cavus or flat feet, and limited ankle dorsiflexion. There have been few studies about the relationship between tightness of the posterior lower limb muscles such as hamstring tightness and plantar fasciitis, and most of them can be interpreted in terms of some contracture of the hamstring muscles of thigh being present in cases of plantar fasciitis. So, we hypothesized there is relation between hamstring tightness and plantar fasciitis. Material and Methods: A total of 68 subjects, 34 with plantar fasciitis and 34 matching controls were recruited. Hamstring was evaluated through the straight leg elevation test, popliteal angle test, and ankle dorsiflexion (with knee extended and knee flexed). At least three measurements were taken and a mean value was calculated. All variables were compared between the 2 groups. Along with hamstring tightness other characteristics such as age, gender, and BMI were also compared. Univariate analysis was done with chi-square test and t-test. Results: Difference between the 2 groups for the tests used to assess hamstring tightness were highly significant i.e., p<0.001 in comparing the values of Popliteal angle (PA) and p=0 of Ankle dorsiflexion with knee flexed (ADFKF), moderately significant i.e. p = 0.032 in comparing the values of Ankle dorsiflexion with knee extended (ADFKE). However, there was no significant difference p=0.588 in comparing the values of Straight leg elevation test (SLET). Since there were significant relation in three parameters PA, ADFKF and ADFKE we can conclude there is hamstring tightness in patients with plantar fasciitis. In comparing the values regarding Body Mass Index between the 2 groups, there was highly significant statistical difference (p<0.001). Conclusion: There is significant association between hamstring tightness in patients with plantar fasciitis. These results of the study suggest that therapists who are going to employ a stretching protocol for treatment of plantar fasciitis should look for hamstring tightness.