Current Diagnosis and Treatment of Necrotizing Fasciitis
Keywords:
necrotizing fasciitis/diagnosis, therapeuctics, surgery, plasticAbstract
Introduction: Necrotizing fasciitis is a rare infectious disease, but frequently misdiagnosed in its initial phase, characterized by tissue necrosis, rapid progression, and fatal complications. Objective: To provide updated knowledge for the comprehensive management and scientific research of necrotizing fasciitis. Methods: For the development of this review, 50 relevant publications were used, between 2019 and 2023, on necrotizing fasciitis in the field of Plastic Surgery and Orthopedics. 109 documents were consulted from the databases of the MEDLINE, PubMed, Scielo reference systems and indexed in the Web of Sciences, Scopus and Redalyc, using the descriptor necrotizing fasciitis. Conclusions: Early diagnosis, intensive treatment, intravenous antibiotic therapy and surgical debridement remain the cornerstone of the management of this disease, in order to reduce the morbidity and mortality rate.
Downloads
References
1.Pinzón-Junca A. ¿Fascitis necrotizante? Acta Med Col [Internet]. 2017 Oct-Dic [citado 10 Feb 2023];42(4):248. Disponible en: https://www.actamedicacolombiana.com/ojs/index.php/actamed/article/view/1414/388
2.Rodríguez Jiménez R, Manuel Antunes MB, Coca Granado RM, Bermúdez Sánchez L, Reyes Luna R, Mena Cardoso A. Fascitis necrotizante cervicofacial de origen odontogénico. Acta méd centro. [Internet]. 2022 Dic [citado 8 Feb 2023];16(4):714-23. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S2709-79272022000400714&Ing=es
3.Rodríguez-Lezcano A, Sánchez-Vinent L, Pacheco-Valdés I. Fascitis necrotizante en región anterior del cuello. Rev Ciencias Médicas [Internet]. 2020 May-Jun [citado 27 Ago 2023];24(3):e4307. Disponible en: http://scielo.sld.cu/pdf/rpr/v24n3/1561-3194-rpr-24-03-e4307.pdf
4.Lau J, Kwok KB, Hung YW, Fan CH. Validation of finger test for necrotizing soft tissue infection. Journal of Orthopaedics, Trauma and Rehabilitation. 2020;20(10):1-6. doi: https://doi.org/10.1177/2210491720961546
5.Jiménez García Y, Correa Martínez L, Trevin Licea MC, Gámez Blanco DI. Fascitis necrotizante. Rev Cubana Cir [Internet]. 2020 Dic [citado 9 Feb 2023];59(4):e970. Disponible en: http://scielo.sld.cu/pdf/cir/v59n4/1561-2945-cir-59-04-e970.pdf
6.Protti DL, Rodríguez Muñoz MJ, Pérez Sánchez P, Sánchez Neila B, López Beneyto J, García Selam M et al. Fascitis necrotizante. Revisión anatómica de la región pélvica y perineal. SERAM [Internet]. 2022 [citado 8 Feb 2023];1(1). Disponible en: https://piper.espacio-seram.com/index.php/seram/article/view/9513
7.Tuta Quintero E, Rueda Rodríguez A, Mantilla Flórez YF. Infecciones necrotizantes de tejidos blandos. ¿cómo identificarlas, clasificarlas y tratarlas? Med Int Méx. 2022;38(3):595-605. doi: https://doi.org/10.24245/mim.v38i3.3963
8.Morún Calvo D, Kriebel Haehner M, González Chavarría A, Zúñiga Villegas A. Actualización en fascitis necrotizante. Rev Cie Sal [Internet]. 2020 [citado 10 Feb 2023];4(4):186-94. Disponible en: https://revistacienciaysalud.ac.cr/ojs/index.php/cienciaysalud/article/view/175/280
9.Ziede RE, Ojeda GJ, Cortés ZM, Laborde RN, Barría AN, Jans BJ. Factores de riesgo asociados a evolución desfavorable en el tratamiento de las infecciones de partes blandas. Rev Cir. [Internet]. 2022 Abr [citado 9 Feb 2023];74(2):149-56. Disponible en http://www.scielo.cl/scielo.php?script=sci_arttex&pid=S2452-45492022000200149&Ing=es
10.Torriente-Vizcaíno L, Cuellar-Herrera D, Pérez-Casales S. Fascitis necrosante abdominal en puérpera de once días. A propósito de un caso. Ginecol Obstet Mex. 2019 Feb;87(2):128-32. doi: https://doi.org/10.24245/gom.v87i2.2648
11.Pérez-Sánchez I, Martínez Gil L, Piqueras-Vidal PM, Pont-Gutiérrez C, Cebrián-Gómez R, Montoza-Nuñez JM. Fascitis necrotizante: experiencia de manejo en las últimas décadas en nuestro centro. Rev Esp Cir Ortop Traumatol. 2022;66(6):429-37 doi: https://doi.org/10.1016/j.recot.2021.12.007
12.Fernández-de-Torres M, Bañuelos-Díaz A, Vaca-Fernández PL, Martín-Blanco S, Barrio-Velasco MJ. Fascitis necrotizante. Diagnóstico y tratamiento a propósito de un caso. Revista Nuevo Hosp [Internet]. 2021 [citado 27 Ene 2023];18(1):46-51. Disponible en: https://www.saludcastillayleon.es/CAZamora/es/publicaciones/revista-nuevo-hospital-2022/nuevo-hospital-2022-febrero-xviii-1/fernandez-torres-m-banuelos-diaz-vaca-fernandez-pl-martin-b
13.Lozano P, Juárez SC, Gallmann AL, Brusa JR, Gómez Zanni MS, Bottiglieri MT, et al. Fascitis necrotizante, cuando el tiempo vale oro. Rev Methodo. 2023 Ene;8(1):43-7. doi: https://doi.org/10.22529/me.2023.8(1)08
14.Liu TJ, Tai HC, Chien KL, Cheng NC. Predisposing factors of necrotizing fasciitis with comparison to cellulitis in Taiwan: A nationwide population-based case-control study. Journal of the Formosan Medical Association. 2020;119(1):18-25. doi: https://doi.org/10.1016/j.jfma.2019.01.014
15.Gönüllü D, Serkan Ilgun A, Demiray O, Sayar S, Muzaffer EA, Kır G, et al. The Potential Prognostic Significance of the Laboratory Risk Indicator for the Necrotizing Fasciitis (LRINEC) Score in Necrotizing Fasciitis. Rev Cirugía. 2019 May-Jun;114(3):376-83. doi: http://dx.doi.org/10.21614/chirurgia.114.3.376
16.Rockbrand Campos LP, Koutsowris Sáenz S, Carrillo Chavarría A. Fascitis necrotizante perineal. Rev Méd Sinerg. [Internet]. 2020 Ago [citado 9 Feb 2025];5(8):e561. Disponible en: https://revistamedicasinergia.com/index.php/rms/article/view/561/928
17.Matus Moro JA, Partido Ramírez A, García Muñoz MSE. Fascitis necrotizante en un neonato. Arch Inv Mat Inf. 2020;11(2):62-5. doi: https://dx.doi.org/10.35366/101552
18. Zhanga Z, Liu P, Yang B, Li J, Wang W, Yang H, et al. Necrotizing fasciitis caused by diabetic foot. International Journal of Infectious Deseases. 2021;103:3-5. doi: https://doi.org/10.1016/j.ijid.2020.11.132
19.William A, Kaur R, Rawat D, Kandir N, Sharma A. Necrotizing fasciitis in neonate by Lichtheimia ramosa: A case report. Access Microbiol. 2022;4(3):000327. doi: https://doi.org/10.1099/acmi.0.000327
20.Elashry MM, Alagha M, Salama M. Pre and retroperitoneal necrotizing fasciitis after COVID-19 infection: A case report. Radiology Case Reports. 2021 Oct;16(10):2949-52. doi: https://doi.org/10.1016/j.radcr.2021.07.009
21.Zhang LX, Liang ZJ, Zhao BY, Shi XW, Zhang T, Liu H, et al. Delayed diagnosis and management of necrotizing fasciitis of the left lower leg. A case report. Medicine. 2022 Oct;101(43):e31231. doi: http://dx.doi.org/10.1097/MD.0000000000031231
22.Cabra Rodríguez R, Ruíz Márquez MJ. Debut pediátrico de fascitis necrotizante. Rev Esp Quimioter. 2020;33(5):383-4. doi: https://doi.org/10.37201/req/036.2020
23.Preda Naumescu A, Elewski B, Tiffany T, Mayo MD. Common Cutaneous Infections: Patient Presentation, Clinical Course, and Treatment Options. Medical Clinics of North American. 2021;105(4):783-97. doi: https://doi.org/10.1016/j.mcna.2021.04.012
24.Huang TY, Peng KT, Hsiao CT, Fann WC, Tsai YH, Li YY, et al. Predictors for gram-negative monomicrobial necrotizing fasciitis in southern Taiwan. BMC Infect Dis. 2020 Ene; 20(60):1-9. doi: https://doi.org/10.1186/s12879-020-4796-3
25.Aguiriano Casanova M del M, Ponce Villar U, Peiró Monzó F, Montesinos C, Seguí J. Diverticulitis perforada causante de fascitis necrotizante de miembro inferior. Cir. Urug. [Internet]. 2022 Ene [citado 10 Feb 2023];6(1):1-2. Disponible en: https://revista.scu.org.uy/index.php/cir_urug/article/view/4918
26.Córdoba-del Castillo MR, Castillo-Ventura BB, Ramírez Hinojosa JP. Fascitis necrotizante cervical: experiencia en el hospital general Dr. Manuel Gea González. México. Acta Otorrinolaringol. cir. cabeza cuello. 2021 Abr-Jun;49(2):129-36. doi: https://doi.org/10.37076/acorl.v49i2.576
27.Kumar M, Lal M. Predictors of mortality in necrotizing fasciitis. Formos J Surg. 2021 Mar;54(2):52-60. doi: https://doi.org/10.4103/fjs.fjs_43_20
28.Hösl VM, Kehrer A, Prantl L. Die Nekrotisierende Fasziitis – ein chirurgischer Notfall. Der Chirurg. 2020;91(10):437-46. doi: https://doi.org/10.1007/s00104-020-01161-3
29.Böttger S, Zechel-Gran S, Schmermund D, Streckbein P, Wilbrand J-F, Knitschke M, et al. Odontogenic Cervicofacial Necrotizing Fasciitis: Microbiological Characterization and Management of Four Clinical Cases. Pathogens. [Internet]. 2022;11(1):78. doi: https://doi.org/10.3390/pathogens11010078
30.Leiblein M, Wagner N, Adam EH, Frank J, Marzi I, Nau C. Clostridial Gas Gangrene – A rate but deadly infection: Case series and comparison to other necrotizing soft tissue infections. Orthopeadic Surgery. [Internet]. 2020 [citado 11 de Feb 2023];12(6):1733-47. Disponible en: https://onlinelibrary.wiley.com/doi/10.1111/os.12804
31.Hsiao CT, Chang CP, Huang TY, Chen YC, Fann WC. Prospective Validation of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) Score for Necrotizing Fasciitis of the Extremities. PLoS ONE. 2020;15(1):e0227748.doi: https://doi.org/10.1371/journal.pone.0227748
32.Van Stigt S, Knubben M, Schrooten T, Tan E. Prognostic factors for mortality in 123 severe cases of necrotizing fasciitis in 5 hospitals in the Netherlands between 2003 and 2017. Eur J Trauma Emerg Surg. 2021;48:1189-95. doi: https://doi.org/10.1007/s00068-021-01706-z
33.Bansal N, Garg N. Evaluation of Laboratory risk indicators (LRINEC Sore) for early diagnosis and prognosis in necrotizing fasciitis. Surgical Review: International Journal of Surgery Trauma and Orthopedics. 2020 May-Jun;6(3):181-8. doi: https://doi.org/10.17511/ijoso.2020.i03.07
34.Kubatz-La-Madrid ME, Cruz-Cruz Y. Fascitis necrotizante, caso clínico. CCM [Internet]. 2022 [citado 9 de feb 2023];26(3): [aprox. 10 p.]. Disponible en: https://revcocmed.sld.cu/index.php/cocmed/article/view/4461
35.Lin CN, Hsiao CT, Chang CP, Huang TY, Hsiao KY, Chen YC. The relationship between fluid accumulation in ultrasonography and the diagnosis and prognosis of patients with necrotizing fasciitis. Ultrasound Med Biol. 2019 Jul;45(7):1545-50. doi: https://doi.org/10.1016/j.ultrasmedbio.2019.02.027
36.Leyva A, Cibulas A, Boron A, Dennison J, Li Marzi G, Jack Porrino, et al. Musculoskeletal Faces of Death: A Diagnostic Imaging Review. Seminars in Roentgenology. 2019 Abr;54(2):190-202. doi: https://doi.org/10.1053/j.ro.2018.09.003
37.Petreanu CA, Constantin T, Losifescu R, Gibu A, Zariosu A, Croitoru A. Necrotizing fasciitis of the chest wall: A clinical case report and literatura review. Exp Ther Med. 2022;23(1):90. Disponible en: https://doi.org/10.3892/etm.2021.11013
38.Tessier JM, Sanders J, Sartelli M, Ulrych J, De Simone B, Grabowski, J, et al. Necrotizing soft tissue infections: A focused review of pathophysiology, diagnosis, operative management, antimicrobial therapy, and pediatrics. Surgical Infections. [Internet]. 2020 [citado 11 de Feb 2023];21(2):81-93. Disponible en: https://digitalcommons.wustl.edu/open_access_pubs/8926
39.Moyano Portillo A, Acosta Martínez del Valle MA, Moya Sánchez E, Ruiz Carazo E. Fascitis necrotizante secundaria a úlcera por presión. Rev Clin Med Fam [Internet]. 2019 [citado 11 Feb 2023];12(1):24-7. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1699-695X2019000100024&lng=es
40.Xu LQ, Zhao XX, Wang PX, Yang J, Yang YM. Multidisciplinry treatment of a patient with necrotizing fasciitis caused by staphylococcus aureus: A report case. World J Clin Cases. 2019;7(21):3595-602. doi: https://doi.org/10.12998/wjcc.v7.i21.3595
41.Sammoni A, Mohamad O, Abdalah A, Alghazali MB, Al-Aissami M. Management of necrotizing fasciitis and the use of sealed irrigation system: A case report. Annals Med Surg. 2022;75:103432. doi: https://doi.org/10.1016/j.amsu.2022.103432
42.Tao XC, Hu DC, Yin LX, Wang C, Lu JG. Necrotizing Fasciitis of cryptoglandular infection treated with multiple incisions and thread-dragging therapy: A case report. World J Clin Cases. 2021 Oct;9(28):8537-44. Disponible en: https://doi.org/10.12998/wjcc.v9.i28.8537
43.Shannon F, Tran A, Wei C, Bram R, Kwadwo K, Seely Andrew S. Necrotizing Soft Tissue Infection: Diagnostic Accuracy of Physical Examination, Imaging, and LRINEC ScoreA Systematic Review and Meta-Analysis. Annals of Surgery. 2019;269(1):58-65. doi: https://doi.org/10.1097/SLA.0000000000002774
44.Joomun MU, Li Z, Xue D, Shao H, Pan Z. Idiopathic necrotizing fasciitis following fracture fixation: A case report. Medicine. 2020 Jun;99(26):e20874. doi: https://doi.org/10.1097/MD.0000000000020874
45.Pérez Breña N, Del río Lago D, Del Toro Finalés O, Polo Hernández L. Ponencia Injerto libre de piel total como alternativa quirúrgica lesiones dermato-oncológicas. Presentación de un caso y revisión de la literatura. Primera Jornada Virtual de CirPlast Sancti Spíritus [Internet]. 2020. [citado 13 Feb 2023];116(1):1-9. Disponible en: http://www.cirplasantisspiritus2020.sld.cu/index.php/crplass/jvccss2020/paper/viewFile/116/65
46.Acosta Romero KV, Mendoza Intriago MA, Moreno Pincay TV, Flores Pozo JT. Injerto de piel en atención de pacientes quemados. RECIMUNDO [Internet]. 2022 Sep [citado 13 Feb 2023];6(3):266-75. Disponible en: https://recimundo.com/index.php/es/article/view/1797
47.Rampal S, Maniam S, Lim PY, Ramachandran R, Kee TE, AsyrafHafizuddin Ab Halim M, et al. Necrotizing fasciitis, causative agents and management: a five-year retrospective study in two tertiary care hospitals in Central Malaysia. International Orthopedics. 2021 Ene; 45:1399-405. doi: https://doi.org/10.1007/s00264-020-04905-2
48.Tamayo-Carbón A, Escobar-Vega H, Cuastimal-Figueroa D. Alcance de las células madre derivadas de tejido adiposo. Rev Cubana de Hematología, Inmunología y Hemoterapia [Internet]. 2021 [citado 12 Feb 2023];37(2):1-20. Disponible en: https://revhematologia.sld.cu/index.php/hih/article/view/1237
49.Planas PM, González PM, Zamora SY, Fuentes C O. Aplicación del plasma rico en plaquetas en la especialidad de cirugía plástica y caumatología. Invest Medico quir [Internet]. 2019[citado 12 Feb 2023];11(1):1-21. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=86709
50.Miquet-Romero L, Tamayo-Carbón A, Posada-Ruiz D, Orozco-Jaramillo M, Sánchez S, Hernández-Collado M. Lisado plaquetario homólogo como factor estimulante de la cicatrización en la zona donante de injertos. Rev Cubana Hematología, Inmunología y Hemoterapia [Internet]. 2021 [citado 13 Feb 2023];37(2):1-17. Disponible en: https://revhematologia.sld.cu/index.php/hih/article/view/1261
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Francisco Xaver Zambrano Guerra, Magda Emilia Alonso Cordero, Omar Martínez Gilimas, Fernando Fernández Fernández

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Medimay protects copyright from the very first moment the submission is made, but upon publication it assumes a Creative Commons 4.0 (cc-by-nc) license, which allows the use of the work to share (copy and redistribute the material in any medium or format) and adapt (remix, transform and build from the material) as long as exclusive mention is made of the publication in the journal as a primary source, prohibiting its commercialization. The author always retains his/her right.