Necrotizing Soft Tissue Infections of the Perineum

Abstract

Necrotizing soft tissue infections of the perineum are rapidly progressing infections associated with significant morbidity and mortality. Prompt diagnosis and management with early surgical debridement is necessary to improve survival from this deadly disease. Repeat debridements are not uncommon. Important adjuncts to surgery include broad-spectrum antibiotics and management in an intensive care unit, as patients frequently develop multisystem organ failure. Once the acute phase is managed, fecal diversion with either an ostomy or fecal management catheter can be considered to decrease soiling of the wound and facilitate healing. Long-term management requires meticulous wound care, often with the assistance of negative pressure wound therapy. Patients may ultimately require skin grafts or tissue flaps for soft tissue coverage following extensive surgical debridements.

Keywords

necrotizing soft tissue infection - Fournier's gangrene - surgical debridement

Publikationsverlauf

Artikel online veröffentlicht:
09. Februar 2022

• References

• 1 Cainzos M, Gonzalez-Rodriguez FJ. Necrotizing soft tissue infections. Curr Opin Crit Care 2007; 13 (04) 433-439
• 2 Sarani B, Strong M, Pascual J, Schwab CW. Necrotizing fasciitis: current concepts and review of the literature. J Am Coll Surg 2009; 208 (02) 279-288
• 3 Bonne SL, Kadri SS. Evaluation and management of necrotizing soft tissue infections. Infect Dis Clin North Am 2017; 31 (03) 497-511
• 4 Jones J. Surgical Memoirs of the War of the Rebellion: Investigation upon the Nature, Causes and Treatment of Hospital Gangrene as Prevailed in the Confederate Armies 1861–1865. New York: US Sanitary Commission; 1871
• 5 Fournier JA. Gangrène foudroyante de la verge. Volume 4. Medicine Pratique; 1883: 589-597
• 6 Nelson GE, Pondo T, Toews KA. et al. Epidemiology of invasive group A streptococcal infections in the United States, 2005-2012. Clin Infect Dis 2016; 63 (04) 478-486
• 7 Faraklas I, Yang D, Eggerstedt M. et al. A multi-center review of care patterns and outcomes in necrotizing soft tissue infections. Surg Infect (Larchmt) 2016; 17 (06) 773-778
• 8 Kihiczak GG, Schwartz RA, Kapila R. Necrotizing fasciitis: a deadly infection. J Eur Acad Dermatol Venereol 2006; 20 (04) 365-369
• 9 Bryant AE, Bayer CR, Chen RY, Guth PH, Wallace RJ, Stevens DL. Vascular dysfunction and ischemic destruction of tissue in Streptococcus pyogenes infection: the role of streptolysin O-induced platelet/neutrophil complexes. J Infect Dis 2005; 192 (06) 1014-1022
• 10 Shiroff AM, Herlitz GN, Gracias VH. Necrotizing soft tissue infections. J Intensive Care Med 2014; 29 (03) 138-144
• 11 Tang LM, Su YJ, Lai YC. The evaluation of microbiology and prognosis of Fournier's gangrene in past five years. Springerplus 2015; 4: 14
• 12 Lee TC, Carrick MM, Scott BG, Hodges JC, Pham HQ. Incidence and clinical characteristics of methicillin-resistant Staphylococcus aureus necrotizing fasciitis in a large urban hospital. Am J Surg 2007; 194 (06) 809-812 , discussion 812–813
• 13 Maltezou HC, Giamarellou H. Community-acquired methicillin-resistant Staphylococcus aureus infections. Int J Antimicrob Agents 2006; 27 (02) 87-96
• 14 Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am 2003; 85 (08) 1454-1460
• 15 Elliott DC, Kufera JA, Myers RA. Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Ann Surg 1996; 224 (05) 672-683
• 16 Hayeri MR, Ziai P, Shehata ML, Teytelboym OM, Huang BK. Soft-tissue infections and their imaging mimics: from cellulitis to necrotizing fasciitis. Radiographics 2016; 36 (06) 1888-1910
• 17 Fernando SM, Tran A, Cheng W. et al. Necrotizing soft tissue infection: Diagnostic accuracy of physical examination, imaging, and LRINEC score: a systematic review and meta-analysis. Ann Surg 2019; 269 (01) 58-65
• 18 Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med 2004; 32 (07) 1535-1541
• 19 Hsiao CT, Chang CP, Huang TY, Chen YC, Fann WC. Prospective validation of the laboratory risk indicator for necrotizing fasciitis (LRINEC) score for necrotizing fasciitis of the extremities. PLoS One 2020; 15 (01) e0227748
• 20 Laor E, Palmer LS, Tolia BM, Reid RE, Winter HI. Outcome prediction in patients with Fournier's gangrene. J Urol 1995; 154 (01) 89-92
• 21 Kabay S, Yucel M, Yaylak F. et al. The clinical features of Fournier's gangrene and the predictivity of the Fournier's Gangrene Severity Index on the outcomes. Int Urol Nephrol 2008; 40 (04) 997-1004
• 22 Sartelli M, Malangoni MA, May AK. et al. World Society of Emergency Surgery (WSES) guidelines for management of skin and soft tissue infections. World J Emerg Surg 2014; 9 (01) 57
• 23 Hietbrink F, Bode LG, Riddez L, Leenen LP, van Dijk MR. Triple diagnostics for early detection of ambivalent necrotizing fasciitis. World J Emerg Surg 2016; 11: 51
• 24 Andreasen TJ, Green SD, Childers BJ. Massive infectious soft-tissue injury: diagnosis and management of necrotizing fasciitis and purpura fulminans. Plast Reconstr Surg 2001; 107 (04) 1025-1035
• 25 McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. Determinants of mortality for necrotizing soft-tissue infections. Ann Surg 1995; 221 (05) 558-563 , discussion 563–565
• 26 Bilton BD, Zibari GB, McMillan RW, Aultman DF, Dunn G, McDonald JC. Aggressive surgical management of necrotizing fasciitis serves to decrease mortality: a retrospective study. Am Surg 1998; 64 (05) 397-400 , discussion 400–401
• 27 Stevens DL, Bisno AL, Chambers HF. et al; Infectious Diseases Society of America. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2015; May 1; 60 (09) 1448
• 28 Stevens DL, Bryant AE, Hackett SP. Antibiotic effects on bacterial viability, toxin production, and host response. Clin Infect Dis 1995; 20 (Suppl. 02) S154-S157
• 29 Lauerman MH, Kolesnik O, Sethuraman K. et al. Less is more? Antibiotic duration and outcomes in Fournier's gangrene. J Trauma Acute Care Surg 2017; 83 (03) 443-448
• 30 Levy MM, Evans LE, Rhodes A. The Surviving Sepsis Campaign Bundle: 2018 update. Intensive Care Med 2018; 44 (06) 925-928
• 31 Linnér A, Darenberg J, Sjölin J, Henriques-Normark B, Norrby-Teglund A. Clinical efficacy of polyspecific intravenous immunoglobulin therapy in patients with streptococcal toxic shock syndrome: a comparative observational study. Clin Infect Dis 2014; 59 (06) 851-857
• 32 Silberstein J, Grabowski J, Parsons JK. Use of a vacuum-assisted device for Fournier's Gangrene: a new paradigm. Rev Urol 2008; 10 (01) 76-80
• 33 Fitzmaurice M, Lawson D, Friedman H. A novel approach for the application of the vacuum assisted closure device to the difficult anatomy. J Plast Reconstr Aesthet Surg 2006; 59 (11) 1249-1250
• 34 Riseman JA, Zamboni WA, Curtis A, Graham DR, Konrad HR, Ross DS. Hyperbaric oxygen therapy for necrotizing fasciitis reduces mortality and the need for debridements. Surgery 1990; 108 (05) 847-850
• 35 Devaney B, Frawley G, Frawley L, Pilcher DV. Necrotising soft tissue infections: the effect of hyperbaric oxygen on mortality. Anaesth Intensive Care 2015; 43 (06) 685-692
• 36 Eskes A, Vermeulen H, Lucas C, Ubbink DT. Hyperbaric oxygen therapy for treating acute surgical and traumatic wounds. Cochrane Database Syst Rev 2013; 12 (12) CD008059
• 37 Levett D, Bennett MH, Millar I. Adjunctive hyperbaric oxygen for necrotizing fasciitis. Cochrane Database Syst Rev 2015; 1 (01) CD007937
• 38 Bronder CS, Cowey A, Hill J. Delayed stoma formation in Fournier's gangrene. Colorectal Dis 2004; 6 (06) 518-520
• 39 Erol B, Tuncel A, Hanci V. et al. Fournier's gangrene: overview of prognostic factors and definition of new prognostic parameter. Urology 2010; 75 (05) 1193-1198
• 40 Korkut M, Içöz G, Dayangaç M. et al. Outcome analysis in patients with Fournier's gangrene: report of 45 cases. Dis Colon Rectum 2003; 46 (05) 649-652
• 41 Klink CD, Lioupis K, Binnebösel M. et al. Diversion stoma after colorectal surgery: loop colostomy or ileostomy?. Int J Colorectal Dis 2011; 26 (04) 431-436
• 42 Person B, Ifargan R, Lachter J, Duek SD, Kluger Y, Assalia A. The impact of preoperative stoma site marking on the incidence of complications, quality of life, and patient's independence. Dis Colon Rectum 2012; 55 (07) 783-787
• 43 Baykara ZG, Demir SG, Karadag A. et al. A multicenter, retrospective study to evaluate the effect of preoperative stoma site marking on stomal and peristomal complications. Ostomy Wound Manage 2014; 60 (05) 16-26
• 44 Nylund G, Oresland T, Hultén L. The trephine stoma: formation of a stoma without laparotomy. Eur J Surg 1997; 163 (08) 627-629
• 45 Eray IC, Alabaz O, Akcam AT. et al. Comparison of diverting colostomy and bowel management catheter applications in Fournier gangrene cases requiring fecal diversion. Indian J Surg 2015; 77 (Suppl. 02) 438-441
• 46 Brown CVR, Teixeira PG, Furay E. et al; AAST Contemporary Management of Rectal Injuries Study Group. Contemporary management of rectal injuries at Level I trauma centers: the results of an American Association for the Surgery of Trauma multi-institutional study. J Trauma Acute Care Surg 2018; 84 (02) 225-233
• 47 Uchino H, Kong V, Elsabagh A. et al. Contemporary management of rectal trauma - a South African experience. Injury 2020; 51 (05) 1238-1241
• 48 Mallikarjuna MN, Vijayakumar A, Patil VS, Shivswamy BS. Fournier's gangrene: current practices. ISRN Surg 2012; 2012: 942437
• 49 Chen SY, Fu JP, Wang CH, Lee TP, Chen SG. Fournier gangrene: a review of 41 patients and strategies for reconstruction. Ann Plast Surg 2010; 64 (06) 765-769
• 50 Glasgow SC, Lowry AC. Long-term outcomes of anal sphincter repair for fecal incontinence: a systematic review. Dis Colon Rectum 2012; 55 (04) 482-490
• 51 Inglin RA, Eberli D, Brügger LE, Sulser T, Williams NS, Candinas D. Current aspects and future prospects of total anorectal reconstruction—a critical and comprehensive review of the literature. Int J Colorectal Dis 2015; 30 (03) 293-302