RESUMEN
OBJECTIVE: The aim of the study is to report a case of multi-focal necrotising fasciitis, review research on this subject to identify common aetiological factors and highlight suggestions to improve management. CONTEXT: Necrotising fasciitis is a severe, life-threatening soft tissue infection that typically arises from a single area, usually secondary to a minor penetrating injury. Multi-focal necrotising fasciitis, where there is more than one non-contiguous area of necrosis, is much less commonly reported. There are no guidelines specific to the management of multi-focal necrotising fasciitis, and its under-reporting may lead to missed management opportunities. DESIGN: A systematic literature review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. DATA SOURCES: A search of MEDLINE, OLD MEDLINE and the Cochrane Collaboration was performed from 1966 to March 2011 using 16 search terms. DATA EXTRACTION: All articles were screened for genuine non-contiguous multi-focal necrotising fasciitis. Of the papers that met this criterion, data on patient demographics, likely inciting injury, presentation time-line, microbial agents, sites affected, objective assessment scores, treatment and outcome were extracted. DATA SYNTHESIS: A total of 31 studies met our inclusion criteria and 33 individual cases of multi-focal necrotising fasciitis were included in the quantitative analysis. About half (52%) of cases were type II necrotising fasciitis; 42% of cases had identifiable inciting injuries; 21% of cases developed multi-focal lesions non-synchronously, of which 86% were type II. Nearly all (94%) of cases had incomplete objective assessment scores. One case identified inflammatory imaging findings prior to clinical necrosis. CONCLUSIONS: Multifocality in necrotising fasciitis is likely to be associated with type II disease. We postulate that validated objective tools will aid necrotising fasciitis management pathways that will identify high-risk groups for multifocality and advise early pre-emptive imaging. We recommend the adoption of regional multi-focal necrotising fasciitis registers.
Asunto(s)
Fascitis Necrotizante/etiología , Fascitis Necrotizante/terapia , Desbridamiento , HumanosRESUMEN
INTRODUCTION: Scald injuries are the commonest cause of paediatric burns leading to hospital admission both in the United Kingdom (National Burn Care Review Committee Report; 2001) and around the world. The cost and significant morbidity resulting from scald injuries reiterates the need for effective prevention campaigns for primary caregivers. The majority of scalds in children occur in the kitchen (49%) at home. Three children a day under the age of 5 (1100/year) are involved in scalds resulting from pulling on a cup of beverage onto themselves. We therefore aim to study the temperature of common beverages made at home and their potential to cause significant thermal injury. MATERIALS AND METHODS: Common household beverages were formulated to assess the thermal characteristics. Each beverage was made in a standardized environment with constant ambient temperature of 22 degrees C. Beverages were made in 230 ml ceramic mugs, using boiled water from an electric kettle, instant coffee granules and teabags. Hot milk and hot water were prepared for comparison. Temperature readings were taken from 0 to 10 min. Cooling curves were then plotted. RESULTS: Milky beverages had the lowest starting temperatures (75-77 degrees C). Black tea and black coffee remained at temperatures greater than 65 degrees C despite cooling for 10 min. The addition of sugar did not alter the cooling rate. Similarly there was very little difference in cooling rates for skimmed and full fat milk. Addition of 10 ml rather than 5 ml of milk lowered the starting temperature and increased the cooling rates. DISCUSSION/CONCLUSION: Hot beverages can cause significant scald injuries especially in the paediatric population. We demonstrated the potential for a full thickness burn despite cooling for 10 min or the addition of cold milk. Thus the complacent attitude surrounding beverages under such conditions should be abolished. Our work also reiterates the need for education amongst caregivers regarding the handling of hot beverages in order to reduce the number of household injuries.