Advertisement

Vulvar Disease pp 303-307 | Cite as

Necrotizing Fasciitis

  • Sara Wood
Chapter

Abstract

Necrotizing fasciitis (NF) of the female vulva and perineum is a life-threatening soft tissue infection. Risk factors include diabetes mellitus, obesity, immunosuppression, intravenous drug and alcohol abuse, trauma, and postoperative surgical wound complication, mainly by group A streptococcus. Diagnosis is timely if the clinician maintains a high index of suspicion for timely diagnosis. Clinical manifestations of NF can be vague, such as tissue erythema, edema, and pain and tenderness out of proportion to clinical exam. The fascial layer undergoes extensive necrosis. Examinations may reveal lack of tissue resistance upon probing, crepitus, skin necrosis, anesthesia, and skin discoloration. In CT scan, fascial edema and increased enhancement may be depicted, as well as subcutaneous air. MRI has high sensitivity for detecting NF. Prompt surgical debridement includes all devitalized tissue. In addition to electrolyte replacement and fluid resuscitation, patients have a better chance of recovery if transferred to intensive critical care unit.

References

  1. 1.
    Nolan T, King L, Smith R, et al. Necrotizing surgical infection and necrotizing fasciitis in obstetric and gynecologic patients. South Med J. 1993;86:1363–7.CrossRefGoogle Scholar
  2. 2.
    Stephenson H, Dotters D, Katz V, et al. Necrotizing fasciitis of the vulva. Am J Obstet Gynecol. 1992;166:1324–7.CrossRefGoogle Scholar
  3. 3.
    Gallup D, Freedman M, Meguiar R, et al. Necrotizing fasciitis in gynecologic and obstetric patients: a surgical emergency. Am J Obstet Gynecol. 2002;187:305–10.CrossRefGoogle Scholar
  4. 4.
    Courtney-Brooks M, Scalici J, Henretta M, et al. Vulvar necrotizing soft tissue infection: a review 73 of a multidisciplinary surgical emergency and management in the modern era. Gynecol Oncol Case Rep. 2013;5:6–9.CrossRefGoogle Scholar
  5. 5.
    Thompson C, Brekken A, Kutteh W. Necrotizing fasciitis: a review of management guidelines in a large obstetrics and gynecology teaching hospital. Infect Dis Obstet Gynecol. 1993;1:16–22.CrossRefGoogle Scholar
  6. 6.
    Rea W, Wyrick W. Necrotizing fasciitis. Ann Surg. 1970;172:957–64.CrossRefGoogle Scholar
  7. 7.
    Faro S, Faro J. Necrotizing soft-tissue infections in obstetric and gynecologic patients. Clin Obstet Gynecol. 2012;55(4):875–87.CrossRefGoogle Scholar
  8. 8.
    Sarani B, Strong M, Pascual J, et al. Necrotizing fasciitis: current concepts and review of the literature. J Am Coll Surg. 2009;208(2):279–88.CrossRefGoogle Scholar
  9. 9.
    Voros D, Pissiotis C, Georgantas D. Role of early and extensive surgery in the treatment of severe necrotizing soft tissue infection. Br J Surg. 1993;80(9):1190–1.CrossRefGoogle Scholar
  10. 10.
    Childers B, Potyondy L, Nachreiner R, et al. Necrotizing fasciitis: a fourteen-year retrospective study of 163 consecutive patients. Am Surg. 2002;68:109–16.PubMedGoogle Scholar
  11. 11.
    Schorge J, Granter S, Lerner L. Postpartum and vulvar necrotizing fasciitis. J Reprod Med. 1998;43(7):586–90.PubMedGoogle Scholar
  12. 12.
    Morris M, Aru M, Gaugler A, et al. Necrotizing fasciitis of the perineum associated with a bartholin abscess. Surg Infect. 2014;15(2):131–3.CrossRefGoogle Scholar
  13. 13.
    Lynch C, Pinelli D, Cruse C, et al. Maternal death from postpartum necrotizing fasciitis arising in an episiotomy: a case report. Infect Dis Obstet Gynecol. 1997;5:341–4.CrossRefGoogle Scholar
  14. 14.
    Flam F, Boijsen M, Lind F. Necrotizing fasciitis following transobturator tape treated by extensive surgery and hyperbaric oxygen. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(1):113–5.CrossRefGoogle Scholar
  15. 15.
    Mahal A, Bradley C. Necrotizing postsurgical infection complicating midurethral sling procedure with unrecognized cystotomy. Female Pelvic Med Reconstr Surg. 2012;18:183–5.CrossRefGoogle Scholar
  16. 16.
    Rimawi B, Soper D, Eschenbach D. Group A streptococcal infections in obstetrics and gynecology. Clin Obstet Gynecol. 2012;55(4):864–74.CrossRefGoogle Scholar
  17. 17.
    Thulin P, Johansson L, Low D, et al. Viable Group A streptococcus in macrophages during acute soft tissue infection. PLoS Med. 2006;3(3):e53.CrossRefGoogle Scholar
  18. 18.
    Wartha F, Beiter K, Normark S, et al. Neutrophil extracellular traps: casting the net over pathogenesis. Curr Opin Microbiol. 2007;10:52–6.CrossRefGoogle Scholar
  19. 19.
    Hackett S, Stevens D. Streptococcal toxic shock syndrome: synthesis of tumor necrosis factor and interleukin-1 by monocytes stimulated with pyrogenic exotoxin A and streptolysin O. J Infect Dis. 1992;165(5):879–85.CrossRefGoogle Scholar
  20. 20.
    Salcido R. Necrotizing fasciitis: reviewing the causes and treatment strategies. Adv Skin Wound Care. 2007;20(5):288–93.CrossRefGoogle Scholar
  21. 21.
    McHenry C, Piotrowski J, Petrinic D, et al. Determinants of mortality for necrotizing soft-tissue infections. Ann Surg. 1995;221(5):558–63.CrossRefGoogle Scholar
  22. 22.
    Wong C, Chang H, Pasupathy S, et al. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg. 2003;85(8):1454–60.CrossRefGoogle Scholar
  23. 23.
    Bilton B, Zibari G, McMillan R. Aggressive surgical management of necrotizing fasciitis serves to decrease mortality: a retrospective study. Am Surg. 1998;64(5):397–400.PubMedGoogle Scholar
  24. 24.
    Elliott D, Kufera J, Myers R. Necrotizing soft tissue infections: risk factors for mortality and strategies for management. Ann Surg. 1996;224(5):672–83.CrossRefGoogle Scholar
  25. 25.
    Haywood C, McGeer A, Low D. Clinical experience with 20 cases of Group A streptococcus necrotizing fasciitis and myonecrosis: 1995–1997. Plast Reconstr Surg. 1999;103(6):1567–73.CrossRefGoogle Scholar
  26. 26.
    Beauchamp N, Scott W, Gottlieb L. CT evaluation of soft tissue muscle infection and inflammation: a systematic compartmental approach. Skeletal Radiol. 1995;24:317–24.CrossRefGoogle Scholar
  27. 27.
    Wang Y, Wong C, Tay Y. Staging of necrotizing fasciitis based on the evolving cutaneous features. Int J Dermatol. 2007;46:1036–41.CrossRefGoogle Scholar
  28. 28.
    Wysoki M, Santora T, Shah R, et al. Necrotizing fasciitis: CT characteristics. Radiology. 1997;203:859–63.CrossRefGoogle Scholar
  29. 29.
    Becker M, Zbaren P, Hermans R, et al. Necrotizing fasciitis of the head and neck: role of CT in diagnosis and management. Radiology. 1997;202:471–6.CrossRefGoogle Scholar
  30. 30.
    Schmid M, Kossmann T, Duewell S. Differentiation of necrotizing fasciitis and cellulitis using MR imaging. AJR Am J Roentgenol. 1998;170:615–20.CrossRefGoogle Scholar
  31. 31.
    Anaya D, McMahon K, Nathens A, et al. Predictors of mortality and limb loss in necrotizing soft tissue infections. Arch Surg. 2005;140:151–7.CrossRefGoogle Scholar
  32. 32.
    Wong C, Khin L, Heng K, et al. 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(7):1535–41.CrossRefGoogle Scholar
  33. 33.
    Cainzos M, Gonzalez-Rodriguez F. Necrotizing soft tissue infections. Curr Opin Crit Care. 2007;13:433–9.CrossRefGoogle Scholar
  34. 34.
    Hsiao G, Chang C, Hsiao C. Necrotizing soft tissue infections: surgical or conservative treatment. Dermatol Surg. 1998;24:243–8.PubMedGoogle Scholar
  35. 35.
    Goh T, Goh L, Ang C, et al. Early diagnosis of necrotizing fasciitis. Br J Surg. 2014;101:e119–25.CrossRefGoogle Scholar
  36. 36.
    Czymek R, Kujath P, Bruch H, et al. Treatment, outcome, and quality of life after Fournier’s gangrene: a multicentre study. Colorectal Dis. 2013;15:1529–36.CrossRefGoogle Scholar
  37. 37.
    Chawla S, Gallop C, Mydlo J. Fournier’s gangrene: an analysis of repeated surgical debridement. Eur Urol. 2003;43:572–5.CrossRefGoogle Scholar
  38. 38.
    Wood S. Clinical manifestations and therapeutic management of vulvar cellulitis and abscess, methicillin-resistant Staphylococcus aureus, necrotizing fasciitis, bartholin abscess, crohn disease of the vulva, hidradenitis suppurativa. Clin Obstet Gynecol. 2015;58(3):503–11.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Sara Wood
    • 1
  1. 1.Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and GynecologyMercy Hospital St. LouisSt. LouisUSA

Personalised recommendations