RESUMEN
Necrotizing soft tissue infection (NSTI) is a life-threatening illness that can seriously harm a person. Over the last years the incidence of NSTI has increased. A rapid and thorough debridement is crucial to let patients survive. After this debridement, patients will often end up with large skin defects. A burn center is specialized in treating skin defects. Patients with large skin defects after the acute phase of NSTI can be referred to this for a multidisciplinary approach. In this article we describe the surgical treatment of the complex wounds of three referred patients with NSTI in our burn center.
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Desbridamiento , Infecciones de los Tejidos Blandos , Humanos , Infecciones de los Tejidos Blandos/terapia , Masculino , Resultado del Tratamiento , Necrosis , Persona de Mediana Edad , Fascitis Necrotizante/terapia , Fascitis Necrotizante/cirugía , Femenino , Adulto , Cicatrización de HeridasRESUMEN
BACKGROUND Necrotizing fasciitis is an aggressive type of skin and soft tissue infection that results in necrosis of subcutaneous tissues, including muscle and fascia. Mixed bacteria, including gas-forming organisms, are usually identified. This report describes a 55-year-old male diabetic patient with herpes zoster involving the thoracic dermatomes complicated by skin infection, necrotizing fasciitis, chest wall abscess, and sepsis. CASE REPORT A 55-year-old man with diabetes mellitus presented with thoracic herpes zoster, initially treated with acyclovir and topical agents. He developed swelling, pain, and fever over the left chest, which was unresponsive to topical treatment. Investigations revealed elevated white blood cells and gas on chest X-ray. Computed tomography confirmed a 13×6×11-cm abscess with gas between the latissimus dorsi and serratus anterior muscles, suggesting necrosis. He received intravenous amoxicillin/clavulanic acid and metronidazole and underwent urgent surgical drainage, yielding 200 mL of pus. Cultures identified antibiotic-sensitive Staphylococcus aureus and Clostridium perfringens. Histopathology confirmed necrotizing tissue with acute bacterial inflammation. He was treated postoperatively with dressings and vacuum-assisted closure, followed by sutures, and was discharged in good condition after 16 days. CONCLUSIONS This case underscores the aggressive nature and potential complications of necrotizing soft tissue infections in patients with diabetes mellitus and herpes zoster. Prompt recognition, early intervention with appropriate antibiotics, and surgical drainage are crucial in managing such infections effectively. The successful use of vacuum-assisted closure therapy underscores its role in facilitating wound healing after debridement. Clinicians should maintain vigilance for necrotizing infections in similar high-risk patients to ensure early intervention and improve clinical outcomes.
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Fascitis Necrotizante , Herpes Zóster , Pared Torácica , Humanos , Fascitis Necrotizante/etiología , Fascitis Necrotizante/terapia , Fascitis Necrotizante/microbiología , Masculino , Persona de Mediana Edad , Herpes Zóster/complicacionesRESUMEN
Necrotizing soft tissue infections are a heterogeneous group of severe infections of the skin, connective tissue and muscles in which necrotic destruction of the tissue occurs at the site of infection. Various bacteria are known as "typical" triggering pathogens and the infection can occur on the entire surface of the body. Necrotizing soft tissue infections are always a time-sensitive emergency associated with high mortality. Many affected patients are critically ill and require treatment in an intensive care unit. The rapid and radical surgical treatment is an essential part of management and in addition an adequate and timely antimicrobial treatment is of great importance. The health consequences for surviving patients are often severe, as extensive soft tissue damage leads to functional impairments. In many cases extensive plastic surgery follow-up is necessary. Therefore, necrotizing soft tissue infections are "complicated" in every phase of the disease and require interprofessional treatment. This review article provides a current overview of various aspects of the diagnostics, treatment and aftercare of necrotizing soft tissue infections.
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Necrosis , Infecciones de los Tejidos Blandos , Humanos , Infecciones de los Tejidos Blandos/terapia , Infecciones de los Tejidos Blandos/diagnóstico , Infecciones de los Tejidos Blandos/microbiología , Infecciones de los Tejidos Blandos/patología , Necrosis/microbiología , Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/terapia , Fascitis Necrotizante/microbiología , Fascitis Necrotizante/patología , Antibacterianos/uso terapéuticoAsunto(s)
Lista de Verificación , Servicio de Urgencia en Hospital , Fascitis Necrotizante , Infecciones de los Tejidos Blandos , Humanos , Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/terapia , Canadá , Infecciones de los Tejidos Blandos/terapia , Antibacterianos/uso terapéutico , Guías de Práctica Clínica como AsuntoRESUMEN
Background: Lack of insurance is associated with poorer outcomes in hospitalized patients. However, few studies have explored this association in hospitalizations for necrotizing soft tissue infections (NSTIs). This study examined the impact of insurance status on the outcome of NSTI admissions. Methods: All adult hospitalizations for necrotizing fasciitis, gas gangrene, and Fournier gangrene between 2016 and 2018 were examined using the Nationwide Inpatient Sample database. Insurance status was categorized as insured (including Medicare, Medicaid, and Private, including Health maintenance organization (HMO) or uninsured (Self-pay). Outcome measures included mortality rates, limb loss, length of hospital stay, prolonged hospital stay, and critical care admissions. Statistical analysis included weighted sample analysis, chi-square tests, multivariate regression analysis, and negative binomial regression modeling. Results: Approximately 29,705 adult hospitalizations for NSTIs were analyzed. Of these, 57.4% (17,065) were due to necrotizing fasciitis, 22% (6,545) to gas gangrene, and 20.5% (6,095) to Fournier gangrene. Approximately 9.7% (2,875) were uninsured, whereas 70% (26,780) had insurance coverage. Among the insured, Medicare covered 39.6% (10,605), Medicaid 29% (7,775), and private insurance 31.4% (8,400). After adjustments, Medicare insurance was associated with greater odds of mortality (adjusted odds ratio [aOR]: 1.81; 95% confidence interval [CI]: 1.33-2.47; p = 0.001). Medicaid insurance was associated with increased odds of amputation (aOR: 1.81; 95% CI: 1.33-2.47; p < 0.001), whereas private insurance was associated with lower odds of amputation (aOR: 0.70; 95% CI: 0.51-0.97; p = 0.030). Medicaid insurance was associated with greater odds of prolonged hospital stay (aOR: 1.34; 95% CI: 1.09-1.64; p < 0.001). No significant association was observed between the lack of insurance or self-pay and the odds of primary or secondary outcomes. Conclusion: Medicare insurance was correlated with greater odds of mortality, whereas Medicaid insurance was associated with increased odds of amputation and longer hospital stay. Uninsured status was not associated with significant differences in NSTI outcomes.
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Fascitis Necrotizante , Hospitalización , Cobertura del Seguro , Infecciones de los Tejidos Blandos , Humanos , Masculino , Femenino , Persona de Mediana Edad , Infecciones de los Tejidos Blandos/epidemiología , Infecciones de los Tejidos Blandos/terapia , Infecciones de los Tejidos Blandos/mortalidad , Infecciones de los Tejidos Blandos/economía , Hospitalización/estadística & datos numéricos , Hospitalización/economía , Anciano , Adulto , Cobertura del Seguro/estadística & datos numéricos , Fascitis Necrotizante/mortalidad , Fascitis Necrotizante/epidemiología , Fascitis Necrotizante/terapia , Estados Unidos/epidemiología , Adulto Joven , Anciano de 80 o más Años , Tiempo de Internación/estadística & datos numéricos , Gangrena Gaseosa/terapia , Gangrena Gaseosa/epidemiología , Adolescente , Pacientes no Asegurados/estadística & datos numéricos , Gangrena de Fournier/terapia , Gangrena de Fournier/mortalidad , Gangrena de Fournier/epidemiología , Seguro de Salud/estadística & datos numéricosRESUMEN
<b><br>Introduction:</b> Necrotizing fasciitis (NF) is an expeditiously escalating inflammatory infection of the fascia, with secondary necrosis of the subcutaneous tissues. To aid diagnosis, the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scoring system was devised to stratify the likelihood of infection in patients on presentation.</br> <b><br>Aim:</b> The study aimed to investigate and quantify the relationships between the LRINEC scoring system and the outcomes such as the need for amputation, length of hospital stay, and mortality in patients with necrotizing fasciitis.</br> <b><br>Material and methods:</b> A total number of 90 patients were admitted with a provisional diagnosis of necrotizing fasciitis. LRINEC score was calculated for each case based on six laboratory variables at the time of presentation. Enrolled patients were divided into three groups on the basis of the LRINEC score. The differences in mortality, length of hospitalization, number of debridement procedures, and need for amputation between these groups were compared.</br> <b><br>Results:</b> Increasing age, male gender, and DM have a poor prognosis in necrotizing fasciitis patients. The amputation and mortality rates are better correlated with higher LRINEC scores.</br> <b><br>Conclusions:</b> The LRINEC score helps in stratifying the patients into three risk categories (low risk, moderate risk, and high risk) according to the severity in a much more organized way, and thus the appropriate management like surgical debridement can be introduced on time. LRINEC score is a robust index that is capable of detecting early cases of necrotizing fasciitis and is simple enough for routine use. It is a simplified bedside diagnostic tool for early diagnosis and prediction of outcomes in patients with necrotizing fasciitis.</br>.
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Fascitis Necrotizante , Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/cirugía , Fascitis Necrotizante/terapia , Humanos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Anciano , Desbridamiento/métodos , Índice de Severidad de la Enfermedad , Tiempo de Internación/estadística & datos numéricos , PronósticoRESUMEN
HISTORY AND CLINICAL FINDINGS: We report on a 34-year-old female patient and a 50-year-old male patient, both of whom were admitted to our emergency department with severe septic conditions. MEDICAL EXAMINATIONS: Both patients were resuscitated and exhibited clinical as well as laboratory evidence of a severe bacterial infection. DIAGNOSIS: Both patients had an invasive infection with Group A Streptococcus. The female patient had a Streptococcal sepsis with severe pneumonia, while the male patient had a Streptococcus-induced necrotizing fasciitis of the upper extremity. THERAPY AND COURSE: While the female patient unfortunately died in the emergency department`s resuscitation room despite all intensive medical treatments, the male patient survived after prompt surgical therapy and an extended stay in the intensive care unit. CONCLUSION: Patients with invasive infections caused by Group A Streptococcus can deteriorate rapidly clinically. Prompt diagnosis and initiation of often interdisciplinary treatment are important. Nevertheless, these conditions can be fatal.
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Fascitis Necrotizante , Infecciones Estreptocócicas , Streptococcus pyogenes , Humanos , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/terapia , Masculino , Femenino , Persona de Mediana Edad , Adulto , Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/terapia , Resultado FatalRESUMEN
INTRODUCTION: Acute epiglottitis is not uncommon and it can cause high mortality due to airway obstruction. Acute epiglottitis complicated with cervical necrotizing fasciitis has rarely been reported, and it is also a life-threatening disease with a fatality rate of 7% to 50%. PATIENT CONCERNS: A 64-year-old woman presented to our hospital with chief complaints of sore throat and cervical swelling, long with foreign body sensation and hoarseness. Endoscopic laryngoscopy showed erythematous and swollen epiglottis with purulent secretions on the surface. Computed tomography (CT) scan showed swollen epiglottis and swelling of the neck with air- and fluid-containing necrotizing tissue. DIAGNOSES: The diagnosis was acute epiglottitis and abscess complicated with cervical necrotizing fasciitis. INTERVENTIONS: With the patient in awake condition, airway access was established by performing intubation with adjunctive use of gum elastic bougie, followed by surgical debridement under general anesthesia; a flap was used for skin coverage and intravenous piperacillin-tazobactam was administered. OUTCOMES: The patient was discharged without complications. CONCLUSION: Gum elastic bougie is a usable tool in difficult intubation. Adequate pre-anesthesia evaluation, patient sedation, and gentle manipulation assured the intubation success in this case.
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Absceso , Epiglotitis , Fascitis Necrotizante , Intubación Intratraqueal , Humanos , Femenino , Fascitis Necrotizante/etiología , Fascitis Necrotizante/terapia , Fascitis Necrotizante/complicaciones , Persona de Mediana Edad , Epiglotitis/complicaciones , Epiglotitis/terapia , Intubación Intratraqueal/métodos , Absceso/etiología , Absceso/terapia , Enfermedad Aguda , Cuello , Desbridamiento/métodos , Laringoscopía/métodos , Antibacterianos/uso terapéutico , Antibacterianos/administración & dosificación , Tomografía Computarizada por Rayos X/métodosRESUMEN
Necrotizing fasciitis (NF) is a rare, dangerous, potentially fatal infectious disease of soft tissue. The treatment consists of antibiotic therapy, surgical debridement and subsequent reconstruction. Hyperbaric oxygen (HBO) therapy has been applied in NF patients recently, so our aim was to gather the findings and outcomes for HBO therapy. A PubMed and Google Scholar literature search was conducted regarding the effect of HBO therapy in patients with NF following key words: 'necrotizing fasciitis' AND 'maxillofacial region' OR 'head and neck' AND 'hyperbaric oxygen' OR 'HBO'. A total of 3333 studies have been identified, of which only 16 articles met the inclusion criteria of this review. A conclusion was made, that aggressive combinations of antibiotics and surgical debridement followed by incorporation of HBO therapy, as an adjuvant treatment, in patients with NF and in company by immunoglobulin therapy are showing promising results. In addition, multi-centric studies should be in consideration for further research.
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Fascitis Necrotizante , Oxigenoterapia Hiperbárica , Humanos , Antibacterianos/uso terapéutico , Desbridamiento/métodos , Fascitis Necrotizante/terapia , Oxigenoterapia Hiperbárica/métodos , Resultado del TratamientoRESUMEN
OBJECTIVES: Necrotizing soft-tissue infection and necrotizing fasciitis of the upper limb are infrequent. Studies are rare, and often include other anatomical regions. The specificities and particularities of this pathology are not well known. The aim of this study was to report diagnosis and treatment aspects. METHODS: A retrospective study was conducted over 10 years on every patient treated for necrotizing fasciitis of the upper limb with clinical, bacteriological and histological confirmation. One hundred ninety-eight items were extracted for each patient concerning clinical, biological, radiological and therapeutic data. RESULTS: During 10 years, 24 patients were diagnosed with necrotizing fasciitis of the upper limb: 18 males, 6 females; mean age, 59.9 years; mean body mass index, 25. Local erythema, pain and fever were the most frequent symptoms. Skin necrosis was present in fewer than 40% of patients. Sixteen cases (66.6%) had prior skin lesions and/or an entry point on the limb. Ten had non-steroidal anti-inflammatory drug prescription before acute symptom onset (42%), requiring intensive care unit admission. Treatment comprised surgical resection, resuscitative measures, antibiotic therapy and reconstructive surgery. Seven patients (30.4%) had 1 session of cutaneous excision, and the others had more than 2. Microbiological analysis found mono-microbial beta-hemolytic group A streptococci (BHGAS) infection in 14 patients (58.4%). Antibiotics were prescribed in 91% of cases before surgery, and in 100% after. The most frequently prescribed substance was clindamycin (18 patients, 75%). Ten patients (42%) stayed in the intensive care unit during treatment. Seventeen patients (70.8%) had thin skin graft reconstruction, including 50% with dermal substitute. Five patients (20.8%) had partial upper limb amputation. Two patients (8.3%) died in the 30 days following diagnosis. CONCLUSIONS: The death rate in necrotizing fasciitis of the upper limb was rather low but the amputation rate was higher than in other locations. This study shows the specific clinical, biological and treatment features of this rare but serious pathology of the upper limb.
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Antibacterianos , Fascitis Necrotizante , Extremidad Superior , Humanos , Masculino , Fascitis Necrotizante/microbiología , Fascitis Necrotizante/terapia , Fascitis Necrotizante/cirugía , Persona de Mediana Edad , Femenino , Estudios Retrospectivos , Anciano , Extremidad Superior/cirugía , Extremidad Superior/microbiología , Adulto , Antibacterianos/uso terapéutico , Desbridamiento , Infecciones de los Tejidos Blandos/microbiología , Infecciones de los Tejidos Blandos/terapia , Anciano de 80 o más Años , Infecciones Estreptocócicas/microbiología , Infecciones Estreptocócicas/terapiaAsunto(s)
Infecciones de los Tejidos Blandos , Humanos , Infecciones de los Tejidos Blandos/terapia , Infecciones de los Tejidos Blandos/tratamiento farmacológico , Antibacterianos/uso terapéutico , Necrosis , Desbridamiento/métodos , Fascitis Necrotizante/terapia , Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/tratamiento farmacológicoRESUMEN
This article aims to provide an overview of common and high-impact medical emergencies that require prompt and effective infectious diseases management. In the described clinical scenarios of malaria, sepsis, necrotizing fasciitis, and meningitis the authors have emphasized the crucial importance of rapid and accurate diagnosis, as well as appropriate treatment from the perspective of infectious diseases. All of these emergencies demand a high degree of clinical suspicion for accurate diagnosis. Some of them also necessitate the involvement of other medical disciplines, such as neurology in the case of meningitis or surgery for necrotizing fasciitis. Additionally, implementing the right empiric antibiotic regimen or, in the case of malaria, antiparasitic treatment is crucial for improving patient outcomes. As patients with these diagnoses may present at any outpatient department, and efficient and quick management is essential, a deep understanding of diagnostic algorithms and potential pitfalls is of the utmost importance.
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Fascitis Necrotizante , Sepsis , Humanos , Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/terapia , Sepsis/diagnóstico , Sepsis/terapia , Urgencias Médicas , Malaria/diagnóstico , Malaria/terapia , Colaboración Intersectorial , Meningitis/diagnóstico , Meningitis/terapia , Comunicación Interdisciplinaria , Enfermedades Transmisibles/diagnóstico , Enfermedades Transmisibles/terapia , AlgoritmosRESUMEN
Introduction: There are inconsistencies in outcome reporting for patients with necrotising soft tissue infections (NSTI). The aim of this study was to evaluate reported outcome measures in NSTI literature that could inform a core outcome set (COS) such as could be used in a study of hyperbaric oxygen in this indication. Methods: A systematic review of all NSTI literature identified from Cochrane, Ovid MEDLINE and Scopus databases as well as grey literature sources OpenGrey and the New York Academy of Medicine databases which met inclusion criteria and were published between 2010 and 2020 was performed. Studies were included if they reported on > 5 cases and presented clinical endpoints, patient related outcomes, or resource utilisation in NSTI patients. Studies did not have to include intervention. Two independent researchers then extracted reported outcome measures. Similar outcomes were grouped and classified into domains to produce a structured inventory. An attempt was made to identify trends in outcome measures over time and by study design. Results: Three hundred and seventy-five studies were identified and included a total of 311 outcome measures. Forty eight percent (150/311) of outcome measures were reported by two or more studies. The four most frequently reported outcome measures were mortality without time specified, length of hospital stay, amputation performed, and number of debridements, reported in 298 (79.5%), 260 (69.3%), 156 (41.6%) and 151 (40.3%) studies respectively. Mortality outcomes were reported in 23 different ways. Randomised controlled trials (RCTs) were more likely to report 28-day mortality or 90-day mortality. The second most frequent amputation related outcome was level of amputation, reported in 7.5% (28/375) of studies. The most commonly reported patient-centred outcome was the SF-36 which was reported in 1.6% (6/375) of all studies and in 2/10 RCTs. Conclusions: There was wide variance in outcome measures in NSTI studies, further highlighting the need for a COS.
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Amputación Quirúrgica , Oxigenoterapia Hiperbárica , Infecciones de los Tejidos Blandos , Humanos , Infecciones de los Tejidos Blandos/terapia , Oxigenoterapia Hiperbárica/estadística & datos numéricos , Oxigenoterapia Hiperbárica/métodos , Amputación Quirúrgica/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Necrosis , Evaluación de Resultado en la Atención de Salud , Fascitis Necrotizante/terapia , Fascitis Necrotizante/mortalidadRESUMEN
BACKGROUND: The role of hyperbaric oxygen therapy (HBOT) in necrotizing soft tissue infections (NSTI) is mainly based on small retrospective studies. A previous study using the 1998-2009 National Inpatient Sample (NIS) found HBOT to be associated with decreased mortality in NSTI. Given the argument of advancements in critical care, we aimed to investigate the continued role of HBOT in NSTI. METHODS: The 2012-2020 National Inpatient Sample (NIS) was queried for NSTI admissions who received surgery. 60,481 patients between 2012-2020 were included, 600 (<1%) underwent HBOT. Primary outcome was in-hospital mortality. Secondary outcomes included amputation, hospital length of stay, and costs. A multivariate model was constructed to account for baseline differences in groups. RESULTS: Age, gender, and comorbidities were similar between the two groups. On bivariate comparison, the HBOT group had lower mortality rate (<2% vs 5.9%, p<0.001) and lower amputation rate (11.8% vs 18.3%, p<0.001) however, longer lengths of stay (16.9 days vs 14.6 days, p<0.001) and higher costs ($54,000 vs $46,000, p<0.001). After multivariate analysis, HBOT was associated with decreased mortality (Adjusted Odds Ratio (AOR) 0.22, 95% CI 0.09-0.53, P<0.001) and lower risk of amputation (AOR 0.73, 95% CI 0.55-0.96, P = 0.03). HBO was associated with longer stays by 1.6 days (95% CI 0.4-2.7 days) and increased costs by $7,800 (95% CI $2,200-$13,300), they also had significantly lower risks of non-home discharges (AOR 0.79, 95%CI 0.65-0.96). CONCLUSIONS: After correction for differences, HBOT was associated with decreased mortality, amputations, and non-home discharges in NSTI with the tradeoff of increase to costs and length of stay.
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Fascitis Necrotizante , Oxigenoterapia Hiperbárica , Infecciones de los Tejidos Blandos , Humanos , Infecciones de los Tejidos Blandos/terapia , Estudios Retrospectivos , Hospitalización , Costos y Análisis de Costo , Fascitis Necrotizante/terapiaRESUMEN
PEDIATRIC NECROTIZING SOFT-TISSUE INFECTIONS. Necrotizing soft-tissue infections (NSTI) include necrotizing forms of fasciitis, myositis, and cellulitis. In children, these are extremely rare conditions with an estimated annual incidence of less than 0.1/100,000 patients aged 0-18 years in France. Nevertheless, the evolution can be very serious (6% mortality, higher than the mortality observed in paediatric intensive care units [PICU]), whereas the initial local symptoms are poor and can be falsely reassuring. The monitoring of a skin infection must be close in order not to ignore the evolution towards a NSTI. In this case, prompt transfer to a PICU with all the necessary technical facilities and used to the management of these rare conditions must be done. Early initiation of antibiotic treatment and aggressive haemodynamic resuscitation according to the latest Surviving Sepsis Campaign guidelines should be a priority. The paediatric surgeon should be called upon as soon as clinical suspicion arises and participate in the frequent clinical reassessment to determine the optimal time to perform the surgical treatment.
INFECTIONS CUTANÉES NÉCROSANTES DE L'ENFANT. Les infections cutanées nécrosantes comprennent les dermo- hypodermites bactériennes nécrosantes (DHBN) et les fasciites nécrosantes (FN). Chez l'enfant, ce sont des pathologies extrêmement rares, avec une incidence annuelle en France estimée inférieure à 0,1/100 000 patients âgés de 0 à 18 ans. Néanmoins, leur évolution peut être gravissime (mortalité de 6 %, supérieure à la mortalité observée habituellement dans les unités de réanimation pédiatrique [URP]) alors que la symptomatologie locale initiale est pauvre et peut faussement rassurer. La surveillance d'une infection cutanée doit être rapprochée afin de ne pas méconnaître l'évolution vers une DHBN-FN. Dans ce cas, une orientation vers une URP disposant de l'ensemble du plateau technique nécessaire, et surtout habituée à gérer ces situations cliniques, est justifié. L'initiation précoce du traitement antibiotique et la prise en charge hémodynamique agressive en suivant les dernières recommandations de la Surviving Sepsis Campaign doivent être une priorité. Le chirurgien pédiatrique doit être appelé dès la suspicion clinique et participer à la réévaluation pluriquotidienne afin de déterminer le moment optimal pour réaliser le traitement chirurgical.
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Fascitis Necrotizante , Sepsis , Infecciones de los Tejidos Blandos , Humanos , Niño , Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/epidemiología , Fascitis Necrotizante/terapia , Infecciones de los Tejidos Blandos/diagnóstico , Infecciones de los Tejidos Blandos/epidemiología , Infecciones de los Tejidos Blandos/terapia , Celulitis (Flemón)/tratamiento farmacológico , Antibacterianos/uso terapéuticoRESUMEN
Hyperbaric oxygen therapy consists of breathing 100% oxygen continuously or intermittently in a chamber at a pressure equal to or greater than 1.4 absolute atmospheres. Indicated for the emergency treatment of carbon monoxide poisoning and other medical-surgical pathologies such as gas embolism or necrotizing soft-tissue infections, various studies have shown a beneficial effect of hyperbaric oxygen therapy in certain ocular pathologies, notably of microcirculatory origin, such as central retinal artery occlusion or macular edema linked to retinal vein occlusions. In addition, hyperbaric oxygen might represent an alternative treatment for ocular quinine toxicity and might also be useful as an adjuvant to surgery and antibiotics in cases of periorbital necrotizing fasciitis. On the other hand, oxygen in high concentrations has toxic ocular effects due to the production of reactive oxygen derivatives.