Skip to main content
SpringerLink
Log in

Necrotizing Fasciitis

  • Chapter
  • First Online:
Pediatric Orthopedic Surgical Emergencies

Abstract

Necrotizing fasciitis is a potentially deadly infection; however, with early recognition and appropriate treatment, the morbidity and mortality can be significantly decreased. This chapter provides a review of the etiologies and ­pathogenesis of necrotizing fasciitis. Additionally, the clues necessary to diagnose this potentially deadly infection are provided as well as the treatment modalities currently available.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hippocrates. Epidemics III, part 4. In: Jones WHS, editor. Hippocrates Collected Works I. Cambridge, MA: Cambridge Harvard University Press; 1868. p. 193–4.

    Google Scholar 

  2. Wilson BL. Necrotizing fasciitis. Am Surg. 1952;18:416–31.

    PubMed  CAS  Google Scholar 

  3. Laupland KB, Davies HD, Low DE, Schwartz B, Green K, McGeer A. Invasive group A streptococcal disease in children and association with varicella-zoster virus infection. Ontario group A streptococcal study group. Pediatrics. 2000;105(5):E60.

    Article  PubMed  CAS  Google Scholar 

  4. Fustes-Morales A, Gutierrez-Castrellon P, et al. Necrotizing fasciitis: report of 39 pediatric cases. Arch Dermatol. 2002;138(7):893–9.

    Article  PubMed  Google Scholar 

  5. McHenry CR, Piotrowski JJ, et al. Determinants of mortality for necrotizing soft tissue infections. Ann Surg. 1995;221(5):558–65.

    Article  PubMed  CAS  Google Scholar 

  6. Bingöl-Koloğlu M, Yildiz RV, et al. Necrotizing fasciitis in children: diagnostic and therapeutic aspects. J Pediatr Surg. 2007;42(11):1892–7.

    Article  PubMed  Google Scholar 

  7. Anaya DA, Dellinger EP. Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis. 2007;44(5):705–10. Epub 2007 Jan 22.

    Article  PubMed  CAS  Google Scholar 

  8. Anaya DA, McMahon K, et al. Predictors of mortality and limb loss in necrotizing soft tissue infections. Arch Surg. 2005;140(2):151–7.

    Article  PubMed  Google Scholar 

  9. Wong CH, Chang HC, et al. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am. 2003;85-A(8):1454–60.

    PubMed  Google Scholar 

  10. Sarani B, Strong M, et al. Necrotizing fasciitis: current concepts and review of the literature. J Am Coll Surg. 2009;208(2):279–88.

    Article  PubMed  Google Scholar 

  11. Macias ES, Pereira FA, et al. Superantigens in dermatology. J Am Acad Dermatol. 2011;64(3):455–72.

    Article  PubMed  CAS  Google Scholar 

  12. McCarthy JJ, Dormans JP, et al. Musculoskeletal infections in children: basic treatment principles and recent advancements. Instr Course Lect. 2005;54:515–28.

    PubMed  Google Scholar 

  13. Delasobera BE, Place R, et al. Serious infectious complications related to extremity cast/splint placement in children. J Emerg Med. 2011;41(1):47–50.

    Article  PubMed  Google Scholar 

  14. Frank G, Mahoney HM, Eppes SC. Musculoskeletal infections in children. Pediatr Clin North Am. 2005;52(4):1083–106.

    Article  PubMed  Google Scholar 

  15. Kaul R, McGeer A, et al. Population-based surveillance for group A streptococcal necrotizing fasciitis: clinical features, prognostic indicators, and microbiologic analysis of seventy-seven cases. Ontario group A streptococcal study. Am J Med. 1997;103(1):18–24.

    Article  PubMed  CAS  Google Scholar 

  16. Hoge CW, Schwartz B, et al. The changing epidemiology of invasive group A streptococcal infections and the emergence of streptococcal toxic shock-like syndrome: a retrospective population-based study. JAMA. 1993;269:384–9.

    Article  PubMed  CAS  Google Scholar 

  17. Torralba KD, Quismorio Jr FP. Soft tissue infections. Rheum Dis Clin North Am. 2009;35(1):45–62.

    Article  PubMed  Google Scholar 

  18. Wang YS, Wong CH, Tay YK. Staging of necrotizing fasciitis based on the evolving cutaneous features. Int J Dermatol. 2007;46(10):1036–41.

    Article  PubMed  Google Scholar 

  19. Wong CH, Khin LW, 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.

    Article  PubMed  Google Scholar 

  20. Ramirez-Schrempp D, et al. Ultrasound soft-tissue applications in the pediatric emergency department: to drain or not to drain? Pediatr Emerg Care. 2009;25(1):44–8.

    Article  PubMed  Google Scholar 

  21. Chau CL, Griffith JF. Musculoskeletal infections: ultrasound appearances. Clin Radiol. 2005;60(2):149–59.

    Article  PubMed  CAS  Google Scholar 

  22. Wyoski MG, Santora TA, et al. Necrotizing fasciitis: CT characteristics. Radiology. 1997;203:859–63.

    Google Scholar 

  23. Schmid MR, Kossman T, Duewell S. Differentiation of necrotizing fasciitis and cellulitis using MR imaging. Am J Roentgenol. 1998;170:615–20.

    CAS  Google Scholar 

  24. Turecki MB, Taljanovic MS, et al. Imaging of musculoskeletal soft tissue infections. Skeletal Radiol. 2010;39(10):957–71.

    Article  PubMed  Google Scholar 

  25. Wong CH, Yam AK, et al. Approach to debridement in necrotizing fasciitis. Am J Surg. 2008;196(3):e19–24.

    Article  PubMed  Google Scholar 

  26. Svoboda SJ, Bice TG, et al. Comparison of bulb syringe and pulsed lavage irrigation with use of a bioluminescent musculoskeletal wound model. J Bone Joint Surg Am. 2006;88:2167–74.

    Article  PubMed  Google Scholar 

  27. Hassinger SM, Harding G, Wongworawat MD. High-pressure pulsatile lavage propagates bacteria into soft tissue. Clin Orthop Relat Res. 2005;439:27–31.

    Article  PubMed  Google Scholar 

  28. Wakhlu A, Chaudhary A, et al. Conservative management of necrotizing fasciitis in children. J Pediatr Surg. 2006;41(6):1144–8.

    Article  PubMed  Google Scholar 

  29. Pandey A, Gangopadhyay AN, et al. Surgical considerations in pediatric necrotizing fasciitis. J Indian Assoc Pediatr Surg. 2009;14(1):19–23.

    Article  PubMed  CAS  Google Scholar 

  30. Clark LA, Moon RE. Hyperbaric oxygen in the treatment of life-threatening soft-tissue infections. Respir Care Clin N Am. 1999;5:203–19.

    PubMed  CAS  Google Scholar 

  31. Waisman D, Shupak A, et al. Hyperbaric oxygen therapy in the pediatric patient: the experience of the Israel Naval Medical Institute. Pediatrics. 1998;102(5):E53.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 2017, Cincinnati, OH, 45229, USA

    Kevin J. Little

  2. Department of Orthopedics, University of Maryland School of Medicine, 1 Texas Station Court, Suite 300, Timonium, MD, 21093, USA

    Joshua M. Abzug MD

Authors
  1. Kevin J. Little
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joshua M. Abzug MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joshua M. Abzug MD .

Editor information

Editors and Affiliations

  1. , Dept. of Orthopedics, University of Maryland School of Medicin, Texas Station Court, Suite 300 1, Timonium, 21093, Maryland, USA

    Joshua M. Abzug

  2. , Orthopedic Center for Children, St. Christopher's Hospital for Children, A Street, Suite 133-1 3601, Philadelphia, 19134-1095, Pennsylvania, USA

    Martin J. Herman

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media New York

About this chapter

Cite this chapter

Little, K.J., Abzug, J.M. (2012). Necrotizing Fasciitis. In: Abzug, J., Herman, M. (eds) Pediatric Orthopedic Surgical Emergencies. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-8005-2_12

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-8005-2_12

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-8004-5

  • Online ISBN: 978-1-4419-8005-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation