• Clindamycin
• Debridement
• Fournier gangrene
• Piperacillin, tazobactam drug combination
• Streptococcus group A

• Fasciitis, Necrotizing/diagnosis
• Fasciitis, Necrotizing/therapy
• Fasciitis, Necrotizing/microbiology
• Fasciitis, Necrotizing/surgery
• Humans
• Anti-Bacterial Agents/therapeutic use
• Debridement
• Shock, Septic/microbiology
• Shock, Septic/diagnosis
• Combined Modality Therapy

• debridement
• infection
• multidisciplinary consultation
• necrotizing fasciitis
• pemphigus

• Spreading Wings Program Research Fund of the first people’s hospital of Changde city
• Changde City Science and Technology Innovation Guidance Project

• NSTI
• microbiology
• necrotizing fasciitis
• necrotizing soft tissue infection
• risk factors

• Humans
• Soft Tissue Infections/diagnosis
• Soft Tissue Infections/therapy
• Prognosis
• Retrospective Studies
• Streptococcus pyogenes
• Disease Progression
• Fasciitis, Necrotizing/diagnosis
• Fasciitis, Necrotizing/therapy

• Periorbital necrotizing fasciitis
• Staphylococcus aureus
• Streptococcus pyogenes
• antibiotic
• superantigens
• surgical debridement
• toxic shock syndrome

• LRINEC
• debridement
• necrotizing fasciitis
• soft tissue infection

Background: Necrotizing fasciitis (NF) is a life-threatening infection of the skin and soft tissue that spreads quickly and requires immediate surgery and medical treatment. Amputation or radical debridement of necrotic tissue is generally always required. The risks and benefits of both the surgical options are weighed before deciding whether to amputate or debride. This study set forth to create an easy-to-use risk scoring system for predicting the risk scoring system for amputation in patients with NF (ANF).

Methods: This retrospective study included 1,506 patients diagnosed with surgically confirmed NF at three general hospitals in Thailand from January 2009 to December 2012. All diagnoses were made by surgeons who strictly observed the guidelines for skin and soft tissue infections produced by the Infectious Diseases Society of America. Patients were randomly allocated to either the derivation (n = 1,193) or validation (n = 313) cohort. Clinical risk factors assessed at the time of recruitment were used to create the risk score, which was then developed using logistic regression. The regression coefficients were converted into item scores, and the total score was calculated.

Results: The following four clinical predictors were used to create the model: female gender, diabetes mellitus, wound appearance stage 3 (skin necrosis and gangrene), and creatinine ≥1.6 mg/dL. Using the area under the receiver operating characteristic curve (AuROC), the ANF system showed moderate power (78.68%) to predict amputation in patients with NF with excellent calibration (Hosmer-Lemeshow χ² = 2.59; p = 0.8586). The positive likelihood ratio of amputation in low-risk (score ≤ 4) and high-risk (score ≥ 7) patients was 2.17 (95%CI: 1.66–2.82) and 6.18 (95%CI: 4.08–9.36), respectively. The ANF system showed good performance (AuROC 76.82%) when applied in the validation cohort.

Conclusion: The developed ANF risk scoring system, which includes four easy to obtain predictors, provides physicians with prediction indices for amputation in patients with NF. This model will assist clinicians with surgical decision-making in this time-sensitive clinical setting.

• ANF risk scoring system
• amputation
• clinical risk scoring model
• necrotizing fasciitis
• patients

• Collagen
• Elastin
• Muscular necroses
• Soft tissue defect
• Tendons

Necrotizing fasciitis is a severe bacterial skin infection that spreads quickly and is characterized by extensive necrosis of the deep and superficial fascia resulting in the devascularization and necrosis of associated tissues. Because of high morbidity and mortality, accurate diagnosis and early treatment with adequate antibiotics and surgical intervention are vital. And timely identification and treatment of complications are necessary to improve survival of patient.

We report a case of necrotizing fasciitis caused by Staphylococcus aureus in a patient using high doses of glucocorticoid and suffering from secondary diabetes mellitus. He was admitted to our hospital due to redness and oedema of the lower limbs. After admission, necrotizing fasciitis caused by Staphylococcus aureus was considered, and he was discharged after B-ultrasound drainage and multiple surgical operations. In the process of treatment, multiple organ functions were damaged, but with the help of multi-disciplinary treatment, the patient got better finally.

The key to successful management of necrotizing fasciitis is an early and accurate diagnosis. The method of using vacuum sealing drainage in postoperative patients can keep the wound dry and clean, reduce infection rate, and promote wound healing. Interdisciplinary collaboration is a vital prerequisite for successful treatment.

• Necrotizing fasciitis
• Surgical debridement
• Vacuum sealing drainage
• Multi-disciplinary treatment
• Case report

Radical surgical intervention is necessary to save patients’ lives in cases of necrotizing fasciitis. This leads to persistent disabilities and most likely to a deteriorated quality of life. The purpose of this study was to evaluate the midterm outcomes after survival of necrotizing fasciitis.

A retrospective analysis of 69 patients, treated for necrotizing fasciitis between 2003 and 2012. The patients were identified using the International Classification of Diseases (10th Revision) code M 72.6. Of the 50 survivors, 22 patients completed the Short Form 36 and Short Musculoskeletal Function Assessment questionnaires as a postal survey. The follow-up averaged 59 months (range: 6–128 months).

The average age at the time of necrotizing fasciitis was 60.0 years. The body mass index average was 29.7. The patients had a significantly decreased physical component summary score of 33.3 compared to a normative group (p < 0.001) (Short Form 36). They further showed a significantly decreased dysfunction and bother indices (Short Musculoskeletal Function Assessment) (p < 0.001). An increased age (⩾70 years) was associated with an inferior role emotional (p = 0.048) and physical functioning (p = 0.011) as well as social functioning (p = 0.038) (Short Form 36). The majority of patients (16, 72.7%) complained of pain at the final follow-up and 50% of patients required an assistive device on a regular basis.

Patients who survived necrotizing fasciitis suffer from functional impairment and changed body appearance. Assistive devices or pain medication are often required, and the patients present with significantly decreased physical, social, and emotional functioning at the midterm follow-up. The patient’s age is a critical factor regarding functional or mental outcome parameters. Further research on the post-hospital course and long-term multidisciplinary care is required to improve the outcomes of these patients.

• Necrotizing fasciitis
• Short Form 36
• Short Musculoskeletal Function Assessment
• amputation
• disability
• infection
• outcome parameters
• surgical debridement

• Dermal substitute
• Necrotizing fasciitis
• Reconstruction
• Soft tissue
• Split thickness skin graft

• Debridement
• Elbow
• Enterococcus
• Infections, Vibrio
• Necrotizing fasciitis

• Hemolytic streptococcal gangrene
• Necrotizing cellulites
• Necrotizing fasciitis
• Soft tissue infection

• Early infection
• Intramedullary nailing
• Necrotizing fasciitis
• Pathergy phenomenon
• Pyoderma gangrenosum

• Injection therapy
• Necrotizing fasciitis
• Necrotizing soft tissue infection

Necrotizing fasciitis is characterized by a fulminant destruction of the soft tissue with an alarmingly high mortality rate. One of the main reasons for the continued high mortality is due to the challenge to punctual recognize and diagnose this disease, as specific cutaneous signs can vary or even be missing early in its evolution – especially in case of simultaneous first manifestation of an acute leukemia.

An untypical case of necrotizing fasciitis disease in a young patient with the first diagnosis of acute myeloid leukemia is presented. After her induction chemotherapy the only presenting clinical sign was fever in the presence of severe neutropenia without an evident infectious focus. After a few days a painless confluent, erythematous, pustular skin rash with a central necrosis on lateral thigh appeared. Escherichia coli was isolated from blood cultures. Surgical debridement was performed and showed subcutaneous tissue, fascia and underlying muscle around the site of initial cutaneous manifestation with typical necrosis on exploration. But, initially taken skin biopsy did not show any typical histopathological findings like bacteria or inflammatory cells confirming necrotizing fasciitis. Nevertheless, the intraoperative findings were impressive and highly indicative for a necrotizing soft tissue infection, so that the patient was treated according to clinical guidelines with extensive recurrent surgical debridement, broad-spectrum antibiotics and intensive care therapy. After recovering from NF, she successfully underwent further chemotherapy and stem cell transplantation.

The presented case highlights the risk of potential misinterpretation, delayed diagnosis and treatment of necrotizing fasciitis in patients presenting with an untypical clinical and histopathological manifestation of necrotizing fasciitis as a result of severe neutropenia following chemotherapy for acute myeloid leukemia.

• Acute myeloid leukemia
• Diagnostic difficulties
• Granulocytopenia
• Necrotizing fasciitis
• Soft tissue infection

• Necrotizing fasciitis
• Necrotizing soft tissue infection
• Procalcitonin

• Anti-Bacterial Agents/therapeutic use
• Combined Modality Therapy
• Critical Care
• Debridement
• Fasciitis, Necrotizing/mortality
• Fasciitis, Necrotizing/therapy
• Fournier Gangrene/mortality
• Fournier Gangrene/therapy
• Gas Gangrene/mortality
• Gas Gangrene/therapy
• Germany
• Humans
• Hyperbaric Oxygenation
• Necrosis
• Skin Diseases, Bacterial/mortality
• Skin Diseases, Bacterial/therapy
• Soft Tissue Infections/mortality
• Soft Tissue Infections/therapy
• Treatment Outcome