Abstract Eleven patients, ranging in age from 3 weeks to 17 years, had acute necrotizing fasciitis. Seven patients developed infection following surgery or trauma. The trunk was the most common site of involvement. Five patients had infection caused by group A β-hemolytic streptococci. Staphylococci, gramnegative organisms, or a mixture of bacteria caused the remainder. Cultures of the involved areas were positive in the ten cases in which specimens were obtained, and blood cultures were positive in eight of ten patients. Extension of infection to underlying muscle occurred in seven cases, and fasciotomy was performed in nine patients. Four patients died and five required skin grafting. Effective therapy must include fasciotomy and extensive debridement in addition to antibiotic administration. References 1. Nelson WE, Vaughan VC, McKay RJ: Textbook of Pediatrics , ed 9. Philadelphia, WB Saunders Co, 1969. 2. Barnett HL: Pediatrics , ed 15. New York, Appleton-Century-Crofts, 1972. 3. Cooke RE, Levin S: The Biologic Basis of Pediatric Practice . New York, McGraw-Hill Book Co Inc, 1968. 4. Hughes JG: Synopsis of Pediatrics , ed 3. St. Louis, CV Mosby Co, 1971. 5. Gellis SS, Kagan BM: Current Pediatric Therapy , ed 5. Philadelphia, WB Saunders Co, 1971. 6. Shirkey HC: Pediatric Therapy , ed 4. St. Louis, CV Mosby Co, 1972. 7. Weinberger M, Haynes RE, Morse TS: Necrotizing fasciitis in a neonate . Am J Dis Child 123:591-594, 1972. 8. Meleney FL: Hemolytic strepotococcus gangrene following scarlet fever antitoxin . Am Surg 91:287-288, 1930. 9. Meleny FL: Hemolytic streptococcus gangrene . Arch Surg 9:317-364, 1924.Crossref 10. White WL: Hemolytic streptococcus gangrene: A report of seven cases . Plast Reconstr Surg 11:1-14, 1953. 11. McCafferty EL Jr, Lyons C: Suppurative fasciitis as the essential feature of hemolytic streptococcus gangrene . Surgery 24:438-442, 1948. 12. Webb HE, et al: Streptococcal gangrene . Arch Surg 85:969-973, 1962.Crossref 13. Beathard GD, Guckian JC: Necrotizing fasciitis due to group A β-hemolytic streptococci . Arch Intern Med 120:63-67, 1972.Crossref 14. Jones J: Investigations Upon the Nature, Causes and Treatment of Hospital Gangrene as It Prevailed in the Confederate Armies 1861-1865. New York, US Sanitary Commission Surgical Memoirs of the War of Rebellion, 1871. 15. Pfanner W: Zur Kenntnis und Behandlung des nekrotisierenden Erysipels . Dtsch Z Chir 144:108-119, 1918.Crossref 16. Wilson B: Necrotizing fasciitis . Am Surg 18:416-431, 1952. 17. Mead JW, Mueller CB: Necrotizing infections of subcutaneous tissue and fascia . Ann Surg 168:274-280, 1968.Crossref 18. Crosthwait RW Jr, Crosthwait RW, Jordan GL: Necrotizing fasciitis . J Trauma 4:149-157, 1964.Crossref 19. Andrews EC, Cruz AB Jr: Necrotizing fasciitis: Diagnosis and treatment . Tex Med 65:50-55, 1969. 20. Rea WJ, Wyrick WJ: Necrotizing fasciitis . Ann Surg 172:959-964, 1970.Crossref 21. Meleney FL: Differential diagnosis between certain types of infectious gangrene of the skin . Surg Gynecol Obstet 56:849-867, 1933. 22. Cotter PW, Morris JB: Acute streptococcal gangrene: Report of a case . J Bone Joint Surg 44B:891-895, 1962. 23. Meleney FL: Hemolytic streptococcus gangrene: Importance of early diagnosis and early operation . JAMA 92:2009-2012, 1929.Crossref 24. Brooks S: Civil War Medicine . Springfield, Charles C Thomas Publisher, 1966, pp 84-85. 25. Strasberg SM, Silver MS: Hemolytic streptococcus gangrene: An uncommon but frequently fatal infection in the antibiotic era . Am J Surg 115:763-768, 1968.Crossref
American Journal of Diseases of Children – American Medical Association
Published: Apr 1, 1973
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