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Published on: March 15, 2024
Necrotizing Fasciitis of the Perineum and the Abdominal Wall-Surgical Approach
Karl-Wilhelm Ecker1,2, Andreas Baars3, John Töpfer4
1Surgical Department, MediClin Müritz-Klinikum GmbH, Waren, Müritz, Germany. karl-wilhelm.ecker@mueritz-klinikum.de.
Abstract:
Necrotizing fasciitis is a synergistic aerobical-anaerobical infection that rapidly spreads from its origin leading to foudroyant increasing soft tissue gangrene and systemic sepsis. In the perineal, perianal and genital regions it is referred to as Fournier's gangrene constituting a clinical entity with the gangrene of the abdominal wall. After a short presentation of the own experience with 17 patients the surgical approach to the life-threatening disease is presented reviewing the former and the recent literature. There is a worldwide consensus that immediate radical excision of the gangrene should be accompanied by intensive care measures. Functional and cosmetic defects are to be reconstructed in a second stage. However, morbidity and mortality remain high in spite of consequent treatment due to often associated significant co-morbidity of affected patients.
Insights
Necrotizing fasciitis, a severe soft tissue infection, requires immediate surgical removal of diseased tissue and intensive care. Despite prompt treatment, high morbidity and mortality persist due to patient co-morbidities.
Area of Science:
- Infectious Diseases
- Surgical Pathology
- Critical Care Medicine
Background:
- Necrotizing fasciitis is a rapidly spreading synergistic infection causing extensive soft tissue gangrene and sepsis.
- Fournier's gangrene is a specific type affecting the perineal, perianal, and genital regions, often involving the abdominal wall.
Purpose of the Study:
- To present the surgical approach for necrotizing fasciitis based on clinical experience with 17 patients.
- To review current and historical literature on the management of this life-threatening condition.
Main Methods:
- Surgical excision of gangrenous tissue.
- Intensive care measures.
- Review of existing medical literature.
Main Results:
- Immediate radical excision of infected tissue combined with intensive care is the consensus approach.
- Reconstruction of defects is performed in a secondary stage.
- High morbidity and mortality rates persist despite treatment, often linked to patient co-morbidities.
Conclusions:
- Prompt surgical intervention and intensive care are crucial for managing necrotizing fasciitis.
- Patient co-morbidity significantly impacts outcomes, contributing to high mortality rates.
