Fascitis necrotizante en puérpera de once días / Necrotizing Fasciitis in Eleven-Day Postpartum

Introducción: La fascitis necrotizante es una infección progresiva poco común, con alta letalidad que puede afectar a cualquier parte del cuerpo, pero es más frecuente en las extremidades, en especial en las piernas, causada en su mayoría por una infección polimicrobiana y se caracteriza por afectar la fascia superficial, tejido subcutáneo, grasa subcutánea con nervios, arterias, venas y fascia profunda. Objetivo: Reportar el caso de una puérpera diagnosticada de fascitis necrotizante. Presentación de caso: Puérpera de 28 años de edad con antecedentes de obesidad e infección por VIH, ingresada en el Servicio de Obstetricia en un hospital de la República Sudafricana, por presentar fiebre, escalofríos y dolor en el abdomen. Se utilizó tratamiento endovenoso con antibióticos y tratamiento quirúrgico. Resultados: Evolución satisfactoria de la paciente sin secuelas. Conclusiones: El diagnóstico oportuno de esta patología permite un accionar temprano, con la consecuente sobrevida de los pacientes(AU)

Introduction: Necrotizing fasciitis is a very lethal uncommon progressive infection that can affect any part of the body, however it is more frequent in the limbs, especially the legs, caused mostly by a polymicrobial infection. It affects the superficial fascia, subcutaneous tissue, subcutaneous fat with nerves, arteries, veins and deep fascia. Objective: To report the case of a puerpera diagnosed with necrotizing fasciitis. Case presentation: A 28-year-old woman with a history of obesity and HIV infection, was admitted to the Obstetrics Service at a hospital in the Republic of South Africa. She had fever, chills and pain in the abdomen. Intravenous treatment with antibiotics and surgical treatment was used. Results: Satisfactory evolution of the patient with no sequelae. Conclusions: The opportune diagnosis of this pathology allows acting early, with the consequent survival of the patients(AU)

Fascitis necrotizante de la pared abdominal como presentación infrecuente de una hernia de Garengeot: caso clínico / Necrotizing fasciitis caused by a Garengeot's hernia: case report

Garengeot's hernia corresponds to the presence of the appendix within a femoral hernia, associated or not with acute appendicitis. The diagnosis of this uncommon situation is usually done during surgery. Furthermore, the clinical presentation as necrotizing fasciitis is a rare condition. We report a 54 years old obese hypertensive woman with rheumatoid arthritis of 40 years of evolution treated with methotrexate and prednisone. She consulted for pain and erythema in the right inguinal region. Laboratory revealed leukocytosis and an elevated C-reactive Protein. Suspecting a cellulitis, the patient was admitted for antimicrobial therapy. A pelvic magnetic resonance imaging showed a perforated acute appendicitis in an inguinal hernia with extensive pelvic cellulitis associated with signs of fasciitis. At surgery, an extensive groin and pubic fasciitis was evident, with a necrotic and perforated appendix within a femoral hernia. Surgical debridement, open appendectomy, and femoral hernioplasty without mesh were carried out. Vacuum-assisted closure was installed in the coverage defect. Three surgical debridement procedures were required for the closure of the wound. Two weeks after the first surgical procedure, the patient was discharged in good condition. During the follow-up, she evolved with a surgical wound dehiscence, which was managed with wound dressings until closure.

Reconstrução de parede abdominal: série de casos / Reconstruction of the abdominal wall: a case series

Introdução: Os pacientes com defeitos de parede abdominal chegam ao consultório do cirurgião plástico em situações muitas vezes complexas, necessitando de abordagem cirúrgica avançada. Métodos: Estudo primário, retrospectivo e descritivo de pacientes submetidos a procedimentos cirúrgicos de reconstrução de parede abdominal pelo Serviço de Cirurgia Plástica do Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE). Resultados: Foram revisados e incluídos os prontuários de 18 pacientes, 15 (83,3%) do sexo feminino e 3 (16,7%) do masculino, com idade variando de 16 a 79 anos (média de 41 anos). Dezessete pacientes possuíam histórico de cirurgia prévia (94,4%), sendo a cesárea presente em 8 dos casos (44,4%), seguida de cirurgia oncológica com 6 (33,3%), cirurgia do trauma com 2 (11,1%) e bariátrica com 2 (11,1%). Em relação à etiologia do defeito, 8 (44,4%) eram decorrentes de fasciite necrosante, 4 (22,2%) de hérnia incisional, 2 (11,1%) por trauma, 2 (11,1%) por infecção de ferida operatória e 2 (11,1%) por neoplasia de parede abdominal, sendo somente um (5,5%) paciente com defeito de espessura total. A técnica cirúrgica de separação dos componentes foi realizada em 7 dos casos (38,9%), seguida de retalho de avanço simples em 6 (33,3%), fechamento com tela associado à abdominoplastia em 3 (16,7%), e expansor tecidual em 2 (11,1%). Quanto às complicações, houve 4 casos (22,2%). Conclusões: Defeitos de parede abdominal são casos desafiadores para o cirurgião plástico, seu tratamento se mostra árduo, porém com resultados satisfatórios mesmo nos casos mais severos.

Introduction: Patients with abdominal wall defects present challenging complications that require the use of advanced surgical approaches. Methods: This primary, retrospective, and descriptive study evaluated patients who underwent abdominal wall reconstruction at the Plastic Surgery Service of the Clinics Hospital of the Federal University of Pernambuco. Results: The medical records of 18 patients were reviewed, including 15 women (83.3%) and 3 men (16.7%), with a mean age of 41 years (range, 16-79 years). Seventeen patients (94.4%) had a history of previous surgery. The causes of abdominal injury were cesarean section in eight cases (44.4%), oncologic surgery in six (33.3%), trauma surgery in two (11.1%), and bariatric surgery in two (11.1%). The etiology of the defect was necrotizing fasciitis in eight cases (44.4%), incisional hernia in four (22.2%), trauma in two (11.1%), surgical wound dehiscence in two (11.1%), abdominal wall neoplasia in two (11.1%), and total thickness defect in one (5.5%). The surgical interventions included the component separation technique in seven cases (38.9%), simple VY advancement flap in six (33.3%), closure with abdominoplasty in three (16.7%), and tissue expander in two (11.1%). Four patients (22.2%) presented complications. Conclusions: Abdominal wall defects are challenging cases for plastic surgeons, as their treatment is difficult, but the results are satisfactory even in the most severe cases.

Complicaciones infecciosas severas del territorio maxilofacial: presentación de casos clínicos / Severe infectious complications of the maxillofacial territory: clinical cases presentation

RESUMEN: Las infecciones en el territorio maxilofacial, son cuadros frecuentes, de origen polimicrobiano, con manifestaciones clínicas muy variables y que están asociadas a múltiples vías de ingreso de los microorganismos al territorio. Un gran porcentaje de estas infecciones se origina en la cavidad oral, principalmente en lesiones bacterianas que sufren los dientes. La compleja anatomía de la cabeza y el cuello, permiten que muchas de estas infecciones se diseminen por espacios profundos, llegando a comprometer órganos o regiones anatómicas adyacentes, que pueden llevar a cuadros clínicos de alto riesgo vital. Los casos clínicos presentados en este artículo corresponden a pacientes tratados en el hospital San Juan de Dios a causa de procesos infecciosos del territorio maxilofacial, por equipos multidisciplinarios.

ABSTRACT: Infections in the maxillofacial territory are frequent cases of polymicrobial origin, with very variable clinical manifestations and are associated with multiple entering pathways of microorganisms in the territory. A large percentage of these infections originate in the oral cavity, mainly in bacterial lesions that undergo experienced by the teeth. The complex anatomy of the head and neck allows many of these infections to spread through deep spaces, leading to compromising adjacent organs or anatomical regions, which can lead to high-risk clinical conditions. The clinical cases presented in this article correspond to patients treated at the San Juan de Dios hospital because of infectious processes of the maxillofacial territory, by multidisciplinary teams.

Síndrome de Fournier: Reconstrução de bolsa testicular com retalho fasciocutâneo de região interna de coxa / Fournier gangrene: Reconstruction of the scrotal sac with a fasciocutaneous flap from the internal thigh region

INTRODUÇÃO: A síndrome de Fournier é uma infecção multibacteriana de rápida progressão em região perineal. Seu tratamento inclui desbridamento, antibioticoterapia de amplo espectro e terapia com oxigênio em câmara hiperbárica. O desbridamento agressivo tipicamente resulta em perda da cobertura cutânea de toda bolsa escrotal, expondo ambos os testículos. No tratamento, é necessária a utilização de retalhos bem vascularizados para o reestabelecimento das funções. MÉTODO: Apresentamos a aplicação de um retalho fasciocutâneo, aproveitando a rica rede arterial da região interna da coxa para a reconstrução perineal, proposto por Ferreira et al., o qual permite o tratamento de amplos defeitos. CONCLUSÃO: O retalho descrito para reconstrução perineal é bastante versátil. Suas vantagens incluem a possibilidade de ser utilizado em diversas situações clínicas, baixo acometimento de gangrena na região doadora, reconstrução em único estágio e a espessura do retalho adequada para reconstrução desta região.

INTRODUCTION: Fournier gangrene is a rapidly progressing multi-bacterial infection in the perineal region. The treatment of this condition includes debridement, broad-spectrum antibiotic therapy, and oxygen therapy in a hyperbaric chamber. Aggressive debridement typically results in the loss of skin coverage of the entire scrotal sac, and the exposure of both testes. During treatment, it is essential to use well-vascularized flaps to ensure the recovery of function. METHOD: We describe the application of a fasciocutaneous flap-which takes advantage of the rich arterial network of the internal region of the thigh-in the perineal reconstruction method proposed by Ferreira et al. that allows for the treatment of large defects. CONCLUSION: The flap is quite versatile. Its advantages include its utility in various clinical situations, low risk of gangrene in the donor area, single-stage reconstruction, and adequate flap thickness for reconstruction.

Management dilemma of cervicofacial necrotizing fasciitis

Cervicofacial necrotizing fasciitis is a rare polymicroibial infection, which carries high morbidity as well as mortality rate. It is usually the result of rapid spread of infection along the fascial planes, causing necrosis of the fascia and overlying skin, which eventually involve the blood vessels and muscles. Early diagnosis is crucial in limiting the fatal consequences of the disease process and the establishment of the appropriate line of management. We discuss the management dilemma in selected cases treated at the Department of Oral and Maxillofacial Surgery, Salmaniya Medical Complex, Bahrain during the period 1 999-2006 and outline briefly the medical as well as the surgical management

Necrotizing skin and soft-tissue infections associated with septicemia: 7 cases report and review.

The authors report seven cases of necrotizing skin and soft-tissue infections, with clinical presenting as hemorrhagic bullae, gangrenous cellulitis or necrotizing fasciitis, in association with septicemia, between January 2003 and January 2007 in Hat Yai Hospital. Six were male and the majority of the lesions, six cases, occurred in the lower extremities. The average age of the patients was 50.0 +/- 11.019 years old. All patients presented with watery diarrhea, severe abdominal pain, high fever and sepsis. The skin lesions were begun with erythema, tender and swelling with formation of hemorrhagic bullae, gangrene and necrosis within 24-48 hours. Three of them were caused by Streptococcus spp., another three by Halophilic Vibrios, and only one by Aeromonas hydrophila. Furthermore, the literatures related with clinical manifestations of necrotizing skin and soft-tissue infections, etiologic pathogens, histological finding, management in setting of sepsis, comorbid conditions, complications and patients' outcome were reviewed.

Regional necrotizing fasciitis and its outcome

Necrotizing fasciitis, a devastating progressive destructive infection of subcutaneous tissue and fascia, is a surgical emergency with a high mortality and morbidity. To analyze the location of necrotizing fasciitis, mode of presentation, microbiological characteristics, comorbid conditions, morbidty and mortality, records were reviewed retrospectively of all ninety-five patients admitted with necrotizing fasciitis to the surgical intensive care unit of Hamad General Hospital between January 1995 and February 2005. Fifteen patients died [15.1%]. All patients had leucocytosis and fever on admission with a mean SOFA score varying from 8 to 10.3 according to the type of necrotizing fasciitis involved [Type 1 or 2] and the regions affected. All received aggressive fluid replacement therapy and all underwent debridement at least twice. The most common comorbid condition was Diabetes mellitus. Type 1 necrotizing fasciitis was common in gluteal, cervical and perineal regions; Type 2 was common in chest, axilla, leg and foot regions. Necrotizing fasciitis of the chest, axilla and gluteal regions had the highest mortality while necrotizing fasciitis of the perineum and genitalia had the lowest mortality

Odontogenic cervical necrotizing fasciitis

Two cases of cervical necrotizing fasciitis, secondary to dental infection, are presented. It is a potentially life-threatening severe mixed infection with rapidly progressive inflammation and necrosis of the fascia, muscle and fat. Laboratory and CT features are described. CT scan was also useful for progress monitoring during the treatment. Both cases were complicated by mediastinitis with pleural effusions. A successful non-fatal outcome was achieved following multiple surgical interventions, aggressive culture based antimicrobial therapy, multi-specialty approach and intensive supportive care of the patients

Fascitis necrotizante cervical / Cervical necrotizing fascitis

La fascitis necrotizante es una infección de las partes blandas caracterizada por su rápida progresión y alta morbimortalidad. La ubicación en cabeza y cuello es poco frecuente, tiende a presentarse secundariamente a focos infecciosos dentarios en pacientes jóvenes. El tratamiento quirúrgico oportuno, el uso de antibióticos y medidas generales, son fundamentales en evitar el alto riesgo de muerte en estos pacientes. Se presentan dos casos de evolución fatal en dos pacientes de edad avanzada y patología concomitante (diabetes mellitus, coronariopatía). En ambos el diagnóstico no fue oportuno, resultando en tratamiento tardío. Se concluye la necesidad de la sospecha clínica de esta patología y del tratamiento oportuno y agresivo. La presunción clínica es fundamental y el diagnóstico precoz debe ser planteado y evaluado con tomografía axial computarizada en todo paciente con infección facial

Fasciite necrosante cervical em lactente: relato de caso e revisao da literatura / Cervical necrotizing fasciitis in infant: case report and literature review

Os autores descrevem e analisam um caso de fasciite necrosante cervical em lactente e revisam a literatura quanto aos aspectos diagnosticos e terapeuticos desta grave infeccao. Destacam no caso presente, a origem em infeccao comum da faringe, a extensa e rapida destruicao dos tecidos cervicais e a concomitancia da sepse. A terapeutica antibiotica dirigida ao Haemophilus sp causador do quadro, o suporte clinico em unidade de terapia intensiva pediatrica, e os repetidos debridamentos cirurgicos, foram fundamentais para a evolucao favoravel do caso