eMedicine Specialties > Emergency Medicine > Infectious Diseases

Necrotizing Fasciitis: Multimedia

Author: Michael Maynor, MD, Clinical Assistant Professor, Department of Hyperbaric/Emergency Medicine, Louisiana State University School of Medicine
Contributor Information and Disclosures

Updated: Mar 25, 2009

Multimedia

Left upper extremity shows necrotizing fasciitis ...Media file 1: Left upper extremity shows necrotizing fasciitis in an individual who used illicit drugs. Cultures grew Streptococcus milleri and anaerobes (Prevotella species). Patient would grease, or lick, the needle before injection.
Left upper extremity shows necrotizing fasciitis ...

Left upper extremity shows necrotizing fasciitis in an individual who used illicit drugs. Cultures grew Streptococcus milleri and anaerobes (Prevotella species). Patient would grease, or lick, the needle before injection.

Necrotizing fasciitis at a possible site of insul...Media file 2: Necrotizing fasciitis at a possible site of insulin injection in the left upper part of the thigh in a 50-year-old obese woman with diabetes.
Necrotizing fasciitis at a possible site of insul...

Necrotizing fasciitis at a possible site of insulin injection in the left upper part of the thigh in a 50-year-old obese woman with diabetes.

Photomicrograph of Fournier gangrene (necrotizing...Media file 3: Photomicrograph of Fournier gangrene (necrotizing fasciitis), oil immersion at 1000X magnification. Note the acute inflammatory cells in the necrotic tissue. Bacteria are located in the haziness of their cytoplasm. Courtesy of Billie Fife, MD, and Thomas A. Santora, MD.
Photomicrograph of Fournier gangrene (necrotizing...

Photomicrograph of Fournier gangrene (necrotizing fasciitis), oil immersion at 1000X magnification. Note the acute inflammatory cells in the necrotic tissue. Bacteria are located in the haziness of their cytoplasm. Courtesy of Billie Fife, MD, and Thomas A. Santora, MD.

More on Necrotizing Fasciitis

Overview: Necrotizing Fasciitis
Differential Diagnoses & Workup: Necrotizing Fasciitis
Treatment & Medication: Necrotizing Fasciitis
Follow-up: Necrotizing Fasciitis
Multimedia: Necrotizing Fasciitis
References

References

  1. Cheng NC, Su YM, Kuo YS, Tai HC, Tang YB. Factors affecting the mortality of necrotizing fasciitis involving the upper extremities. Surg Today. 2008;38(12):1108-13. [Medline].

  2. Mao JC, Carron MA, Fountain KR, Stachler RJ, Yoo GH, Mathog RH, et al. Craniocervical necrotizing fasciitis with and without thoracic extension: management strategies and outcome. Am J Otolaryngol. Jan-Feb 2009;30(1):17-23. [Medline].

  3. Baker DJ. Selected aerobic and anaerobic soft tissue infections - diagnosis and the use of hyperbaric oxygen. Hyperbaric Medicine Practice. 1994;395-418.

  4. Baracco GJ, Bisno AL. Therapeutic Approaches to Streptococcal Toxic Shock Syndrome. Curr Infect Dis Rep. Aug 1999;1(3):230-237. [Medline].

  5. Brothers TE, Tagge DU, Stutley JE, et al. Magnetic resonance imaging differentiates between necrotizing and non-necrotizing fasciitis of the lower extremity. J Am Coll Surg. Oct 1998;187(4):416-21. [Medline].

  6. Cullen TS. A progressively enlarging ulcer of abdominal wall involving the skin and fat, following drainage of an abdominal abscess apparently of appendiceal origin. Surg Gynecol Obstet.

  7. Demello FJ, Haglin JJ, Hitchcock CR. Comparative study of experimental Clostridium perfringens infection in dogs treated with antibiotics, surgery, and hyperbaric oxygen. Surgery. Jun 1973;73(6):936-41. [Medline].

  8. Eke N. Fournier's gangrene: a review of 1726 cases. Br J Surg. Jun 2000;87(6):718-28. [Medline].

  9. File TM, Tan JS. Group A streptococcus necrotizing fasciitis. Compr Ther. 2000;26(2):73-81. [Medline].

  10. Fink S, Chaudhuri TK, Davis HH. Necrotizing fasciitis and malpractice claims. South Med J. Aug 1999;92(8):770-4. [Medline].

  11. Fournier JA. Jean-Alfred Fournier 1832-1914. Gangrene foudroyante de la verge (overwhelming gangrene). Sem Med 1883. Dis Colon Rectum. Dec 1988;31(12):984-8. [Medline].

  12. Fujisawa N, Yamada H, Kohda H, et al. Necrotizing fasciitis caused by Vibrio vulnificus differs from that caused by streptococcal infection. J Infect. May 1998;36(3):313-6. [Medline].

  13. Hart GB, Lamb RC, Strauss MB. Gas gangrene. J Trauma. Nov 1983;23(11):991-1000. [Medline].

  14. Hirn M, Niinikoski J, Lehtonen OP. Effect of hyperbaric oxygen and surgery on experimental gas gangrene. Eur Surg Res. 1992;24(6):356-62. [Medline].

  15. Holmstrom B, Grimsley EW. Necrotizing fasciitis and toxic shock-like syndrome caused by group B streptococcus. South Med J. Nov 2000;93(11):1096-8. [Medline].

  16. Hsiao GH, Chang CH, Hsiao CW, et al. Necrotizing soft tissue infections. Surgical or conservative treatment?. Dermatol Surg. Feb 1998;24(2):243-7; discussion 247-8. [Medline].

  17. Jones RB, Hirschmann JV, Brown GS, Tremann JA. Fournier's syndrome: necrotizing subcutaneous infection of the male genitalia. J Urol. Sep 1979;122(3):279-82. [Medline].

  18. Kaul R, McGeer A, Low DE, 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. Jul 1997;103(1):18-24. [Medline].

  19. Korhonen K, Kuttila K, Niinikoski J. Tissue gas tensions in patients with necrotising fasciitis and healthy controls during treatment with hyperbaric oxygen: a clinical study. Eur J Surg. Jul 2000;166(7):530-4. [Medline].

  20. Lamerton AJ. Fournier's gangrene: non-clostridial gas gangrene of the perineum and diabetes mellitus. J R Soc Med. Apr 1986;79(4):212-5. [Medline].

  21. Larsson A, Elmqvist, Stenberg A. Cervical necrotizing fasciitis - 11 cases treated according to a multidisciplinary protocol. Undersea Hyperb Med. 2002;29(2):105.

  22. Mader JT. Mixed anaerobic and aerobic soft tissue infection. In: Problem Wounds: The Role of Oxygen. 1988:173-186.

  23. McGeehan DF, Asmal AB, Angorn IB. Fournier's gangrene. S Afr Med J. Nov 10 1984;66(19):734-7. [Medline].

  24. Meleney FL. Hemolytic streptococcus gangrene. Arch Surg. 1924;9:317-364. [Medline].

  25. Mohammedi I, Ceruse P, Duperret S, Vedrinne J, Boulétreau P. Cervical necrotizing fasciitis: 10 years' experience at a single institution. Intensive Care Med. Aug 1999;25(8):829-34. [Medline].

  26. Mulla ZD. Hyperbaric oxygen in necrotizing fasciitis. Plast Reconstr Surg. Dec 2008;122(6):1984-5. [Medline].

  27. Niinikoski J, Aho A. Combination of hyperbaric oxygen, surgery and antibiotics in the treatment of clostridial gas gangrene. Infect Surg. 1983;2:23-27.

  28. Nomikos IN. Necrotizing perineal infections (Fournier's disease): old remedies for an old disease. Int J Colorectal Dis. 1998;13(1):48-51. [Medline].

  29. Reyzelman AM, Armstrong DG, Vayser DJ, et al. Emergence of non-group A streptococcal necrotizing diabetic foot infections. J Am Podiatr Med Assoc. Jun 1998;88(6):305-7. [Medline].

  30. Riseman JA, Zamboni WA, Curtis A, et al. Hyperbaric oxygen therapy for necrotizing fasciitis reduces mortality and the need for debridements. Surgery. Nov 1990;108(5):847-50. [Medline].

  31. Somers WJ, Lowe FC. Localized gangrene of the scrotum and penis: a complication of heroin injection into the femoral vessels. J Urol. Jul 1986;136(1):111-3. [Medline].

  32. Sriskandan S, Kemball-Cook G, Moyes D, et al. Contact activation in shock caused by invasive group A Streptococcus pyogenes. Crit Care Med. Nov 2000;28(11):3684-91. [Medline].

  33. Stephenson H, Dotters DJ, Katz V, Droegemueller W. Necrotizing fasciitis of the vulva. Am J Obstet Gynecol. May 1992;166(5):1324-7. [Medline].

  34. Stevens DL, Bryant AE, Adams K, Mader JT. Evaluation of therapy with hyperbaric oxygen for experimental infection with Clostridium perfringens. Clin Infect Dis. Aug 1993;17(2):231-7. [Medline].

  35. Wilkinson D, Doolette D. Hyperbaric oxygen treatment and survival from necrotizing soft tissue infection. Arch Surg. Dec 2004;139(12):1339-45. [Medline].

  36. Wysoki MG, Santora TA, Shah RM, Friedman AC. Necrotizing fasciitis: CT characteristics. Radiology. Jun 1997;203(3):859-63. [Medline].

  37. Zamboni WA, Mazolewski PJ, Erdmann D, et al. Evaluation of penicillin and hyperbaric oxygen in the treatment of streptococcal myositis. Ann Plast Surg. Aug 1997;39(2):131-6. [Medline].

  38. Zerr DM, Alexander ER, Duchin JS, et al. A case-control study of necrotizing fasciitis during primary varicella. Pediatrics. Apr 1999;103(4 Pt 1):783-90. [Medline].

  39. Zerr DM, Rubens CE. NSAIDS and necrotizing fasciitis. Pediatr Infect Dis J. Aug 1999;18(8):724-5. [Medline].

  40. Zurawski CA, Bardsley M, Beall B, et al. Invasive group A streptococcal disease in metropolitan Atlanta: a population-based assessment. Clin Infect Dis. Jul 1998;27(1):150-7. [Medline].

Further Reading

Keywords

Fournier's gangrene, Fournier gangrene, Meleney's ulcer, Meleney ulcer, postoperative progressive bacterial synergistic gangrene, flesh-eating bacteria, Cullen's ulcer, Cullen ulcer, hemolytic streptococcal gangrene, acute dermal gangrene, hospital gangrene, suppurative fascitis, synergistic necrotizing cellulitis, group A hemolytic streptococci, Staphylococcus aureus, Bacteroides fragilis, Escherichia coli, nonclostridial myonecrosis, Vibrio vulnificus, diabetes mellitus, fascial necrosis

Contributor Information and Disclosures

Author

Michael Maynor, MD, Clinical Assistant Professor, Department of Hyperbaric/Emergency Medicine, Louisiana State University School of Medicine
Michael Maynor, MD is a member of the following medical societies: Society for Academic Emergency Medicine and Undersea and Hyperbaric Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Eric M Kardon, MD, FACEP, Attending Emergency Physician, Georgia Emergency Medicine Specialists; Physician, Division of Emergency Medicine, Athens Regional Medical Center
Eric M Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eric L Weiss, MD, DTM&H, Director of Stanford Travel Medicine, Medical Director of Stanford Lifeflight, Assistant Professor, Departments of Emergency Medicine and Infectious Diseases, Stanford University School of Medicine
Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Association for Oncology, Southern Clinical Neurological Society, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.