Cargando…

Triple diagnostics for early detection of ambivalent necrotizing fasciitis

BACKGROUND: Necrotizing fasciitis is an uncommon, rapidly progressive and potential lethal condition. Over the last decade time to surgery decreased and outcome improved, most likely due to increased awareness and more timely referral. Early recognition is key to improve mortality and morbidity. How...

Descripción completa

Detalles Bibliográficos
Autores principales: Hietbrink, Falco, Bode, Lonneke G., Riddez, Louis, Leenen, Luke P. H., van Dijk, Marijke R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5057419/
https://www.ncbi.nlm.nih.gov/pubmed/27766113
http://dx.doi.org/10.1186/s13017-016-0108-z
_version_ 1782459063978688512
author Hietbrink, Falco
Bode, Lonneke G.
Riddez, Louis
Leenen, Luke P. H.
van Dijk, Marijke R.
author_facet Hietbrink, Falco
Bode, Lonneke G.
Riddez, Louis
Leenen, Luke P. H.
van Dijk, Marijke R.
author_sort Hietbrink, Falco
collection PubMed
description BACKGROUND: Necrotizing fasciitis is an uncommon, rapidly progressive and potential lethal condition. Over the last decade time to surgery decreased and outcome improved, most likely due to increased awareness and more timely referral. Early recognition is key to improve mortality and morbidity. However, early referral frequently makes it a challenge to recognize this heterogeneous disease in its initial stages. Signs and symptoms might be misleading or absent, while the most prominent skin marks might be in discrepancy with the position of the fascial necrosis. Gram staining and especially fresh frozen section histology might be a useful adjunct. METHODS: Retrospective analysis of 3 year period. Non-transferred patients who presented with suspected necrotizing fasciitis are included. ASA classification was determined. Mortality was documented. RESULTS: In total, 21 patients are included. Most patients suffered from severe comorbidities. In 11 patients, diagnoses was confirmed based on intra-operative macroscopic findings. Histology and/or microbiotic findings resulted in 6/10 remaining patients in a change in treatment strategy. In total, 17 patients proved to suffer necrotizing fasciitis. In the cohort series 2 patients died due to necrotizing fasciitis CONCLUSION: In the early phases of necrotizing fasciitis, clinical presentation can be ambivalent. In the present cohort, triple diagnostics consisting of an incisional biopsy with macroscopic, histologic and microbiotic findings was helpful in timely identification of necrotizing fasciitis.
format Online
Article
Text
id pubmed-5057419
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-50574192016-10-20 Triple diagnostics for early detection of ambivalent necrotizing fasciitis Hietbrink, Falco Bode, Lonneke G. Riddez, Louis Leenen, Luke P. H. van Dijk, Marijke R. World J Emerg Surg Research Article BACKGROUND: Necrotizing fasciitis is an uncommon, rapidly progressive and potential lethal condition. Over the last decade time to surgery decreased and outcome improved, most likely due to increased awareness and more timely referral. Early recognition is key to improve mortality and morbidity. However, early referral frequently makes it a challenge to recognize this heterogeneous disease in its initial stages. Signs and symptoms might be misleading or absent, while the most prominent skin marks might be in discrepancy with the position of the fascial necrosis. Gram staining and especially fresh frozen section histology might be a useful adjunct. METHODS: Retrospective analysis of 3 year period. Non-transferred patients who presented with suspected necrotizing fasciitis are included. ASA classification was determined. Mortality was documented. RESULTS: In total, 21 patients are included. Most patients suffered from severe comorbidities. In 11 patients, diagnoses was confirmed based on intra-operative macroscopic findings. Histology and/or microbiotic findings resulted in 6/10 remaining patients in a change in treatment strategy. In total, 17 patients proved to suffer necrotizing fasciitis. In the cohort series 2 patients died due to necrotizing fasciitis CONCLUSION: In the early phases of necrotizing fasciitis, clinical presentation can be ambivalent. In the present cohort, triple diagnostics consisting of an incisional biopsy with macroscopic, histologic and microbiotic findings was helpful in timely identification of necrotizing fasciitis. BioMed Central 2016-10-11 /pmc/articles/PMC5057419/ /pubmed/27766113 http://dx.doi.org/10.1186/s13017-016-0108-z Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Hietbrink, Falco
Bode, Lonneke G.
Riddez, Louis
Leenen, Luke P. H.
van Dijk, Marijke R.
Triple diagnostics for early detection of ambivalent necrotizing fasciitis
title Triple diagnostics for early detection of ambivalent necrotizing fasciitis
title_full Triple diagnostics for early detection of ambivalent necrotizing fasciitis
title_fullStr Triple diagnostics for early detection of ambivalent necrotizing fasciitis
title_full_unstemmed Triple diagnostics for early detection of ambivalent necrotizing fasciitis
title_short Triple diagnostics for early detection of ambivalent necrotizing fasciitis
title_sort triple diagnostics for early detection of ambivalent necrotizing fasciitis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5057419/
https://www.ncbi.nlm.nih.gov/pubmed/27766113
http://dx.doi.org/10.1186/s13017-016-0108-z
work_keys_str_mv AT hietbrinkfalco triplediagnosticsforearlydetectionofambivalentnecrotizingfasciitis
AT bodelonnekeg triplediagnosticsforearlydetectionofambivalentnecrotizingfasciitis
AT riddezlouis triplediagnosticsforearlydetectionofambivalentnecrotizingfasciitis
AT leenenlukeph triplediagnosticsforearlydetectionofambivalentnecrotizingfasciitis
AT vandijkmarijker triplediagnosticsforearlydetectionofambivalentnecrotizingfasciitis