Necrotizing_Fasciitis Nabil Almekhlafi.ppt

Research my work at MSF , in Yemen at 2018 where we received a lot of patients with necrotizing fasciitis

1. Short Term Experience
of Treatment
Necrotizing Fasciitis
Dr Nabil Almekhlafi
General Surgery
Taiz University

2. Background
•A rapidly advancing soft tissue infection.
•Widespread fascial necrosis.
•Un common and high mortality
•Polymicrobial
•Heterogeneous Disease .

3. Types
•Type I is polymicrobial
•Type II is group A strep
•Type III is gas gangrene or clostridial
myonecrosis.

4. Pathophysiology
•Organisms spread from skin along
superficial and deep planes, facilitated by
bacterial enzymes and toxins.
•Infection causes vascular occlusion,
ischemia, necrosis.
•Superficial nerves damaged, producing
anesthesia.
•Septicemia may developed

7. Patients and Methods
•We retrospectively reviewed all
 
Necrotizing
Fasciitis 
cases at Alqaeda Hospital , Under
MSF Project Guidance , from January 2020
to December 2020.
• N.F. diagnosed clinically and confirmed
intraoperatively .

8. Patients’ demographic and clinical
characteristics (N 
= 39)
variable N
 (%)
Age (years) 45.15 (y)
Male 33(84.62%)
Female 6(15.38%)
 Lower extremities 22(56.41%)
Upper extremities 7(17.95%)
Trunk 4(10.26%)
Perineal (Fourneir) 6(15.38%)
Diabetes mellitus 11(28.21%)
Causative Factors
Minor Injury
17(43.59%)

9. Clinically Diagnosed
•General findings include:
Severe Tenderness , Rapidly advancing
erythema , Tense Swelling , Skin Blackish
discolourization , Eschar, hemorrhagic
Bulla
•Crepitus rare finding and late sign.
• WBC elevated

14. Treatment Protocol
•Treat without delay
•ICU admission , Monitor hemodynamics
•Antibiotics- combination
•Aggressive Debridement
•Team approach
• Holistic approach
•TIME concept

15. Antibiotics
•Combination: cover G+ , G- and anaerobes.
•Clindamycin , gentamicin, Ceftriaxone
•Vancomycin for methicillin resistant staph.

16. Surgical Care
•Immediate debridement
•Do it over and over.
•Incisions should be deep and extend to healthy
tissue. Excise necrotic areas
• Irrigate by NS
• Dressing changes
•Amputation may be required .
• Reevaluation after 24h-36h

21. Results
•Out of 39 cases of
 N.F. enrolled one case died (2.56%)
• 2 cases (5.13%) personally decided to discontinue
treatment at our surgical unit
• There is no Amputation for any case
• Average hospitalization is 19.67 days
• Average of DBR at OT was 7.48 times
• 35 (89.74%) cases underwent successful reconstructive
surgery , and discharged with good condition .
•One case still hospitalization

27. Conclusions
•Incidence of N.F. in Yemen is higher than other
countries , is not uncommon .
• early detection and aggressive debridement are the
cornerstones of NF treatment .
•Specialized Centre and multidisciplinary team is
essential for good medical services for N.F.
patients .
• Education of appropriate management of
minor injury may decrease incidence rate .
• Causative organisms in Yemen need more studies .

28. ةليمجلاانتريزج
ةرطقس