%0 Journal Article
%T Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs
%A Zdravko Roje
%A £¿eljka Roje
%A Dario Mati£¿
%A Davor Librenjak
%A Stjepan Dokuzovi£¿
%A Josip Varvodi£¿
%J World Journal of Emergency Surgery
%D 2011
%I BioMed Central
%R 10.1186/1749-7922-6-46
%X Necrotizing soft tissue infection (NSTI) is a rare but potentially fatal infection involving skin, subcutaneous tissue and muscle [1]. It is usually accompanied by the systemic inflammatory response syndrome (SIRS) and needs prolonged intensive care treatment [2]. Necrotizing fasciitis is characterized by widespread necrosis of the subcutaneous tissue and fasciae. However NF as a soft tissue infection "per se" typically does not cause myonecrosis, but does invade the deep fascia and muscle [3]. Its rapid and destructive clinical course is assumed to be caused by polymicrobial symbiosis and synergy [1,2]. Monomicrobial infection is usually associated with immunocompromised patients (cancer, diabetes mellitus, vascular insufficiencies, organ transplantation or alcohol abusers) [4]. Many aerobic and anaerobic pathogens may be involved, including Bacteroides, Clostridium, Peptostreptococcus, Enterobacteriaciae, Proteus, Pseudomonas, and Klebsiella, but group A hemolytic streptococcus and Staphylococcus aureus, alone or in synergism, are the initiating infecting bacteria [5]. Typical sites of the infection are the extremities, (primarily the lower extremities), abdomen, and perineum [1]. In most NSTI cases anaerobic bacteria are present, usually in combination with aerobic gram-negative organisms. They proliferate in an environment of local tissue hypoxia. Because of lower oxidation-reduction potential, they produce gases such as hydrogen, nitrogen, hydrogen sulfide and methane, which accumulate in soft tissue spaces because of reduced solubility in water [6]. Establishing the diagnosis of NF (as the most common type of NSTI) can be challenging. Clinical findings may include swelling, pain, fever, erythema, induration, crepitations, sloughing off of the skin, or a blistering and purulent collection. The need for more rapid and scientific methods of NF diagnosis led to the development of a clinical scoring systems, like the LRINEC scoring system (The Laboratory Risk Indic
%U http://www.wjes.org/content/6/1/46