Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai JiaoTong University, Shanghai, China.
Department of Orthopedic Surgery, Hunan Want Want Hospital, Changsha, Hunan, China.
Surg Infect (Larchmt). 2021 May;22(4):363-373. doi: 10.1089/sur.2020.071. Epub 2020 Oct 7.
Necrotizing fasciitis (NF) is a rare, rapidly progressing, and potentially fatal tissue infection involving subcutaneous tissue, superficial fascia, and the overlying skin. Breast NF is often misdiagnosed because of the thick breast tissue between the skin and deep fascia. Only early diagnosis followed by prompt antibiotic treatment and surgical therapy can prevent disastrous consequences. There are many case reports on breast NF, but a systematic review is lacking. Using PubMed and Scopus we performed a systematic review of the literature covering a period of 20 years. We reviewed articles with predisposing comorbidities (risk factors), triggering factors, laboratory examinations, culture of organisms, antibiotic treatment, surgical interventions, the presence of septic shock, and final outcome. We also performed statistical tests of all these factors in relation to death. Forty cases identified from 38 articles were included in our literature review. Twenty-one cases (52.5%) were primary, whereas 15 cases (37.5%) occurred after surgery. In 15 cases (37.5%), the single organism responsible for NF was , whereas mixed organisms were found in 17 cases (42.5%). Surgical debridement was performed in 39 (97.5%) cases. Septic shock was found in all five (12.5%) deceased cases and was associated with patient's mortality (p < 0.001). Breast NF is a rare, severe, and easily misdiagnosed complication. Breast NF could differ from that in other body regions in etiology pattern and clinical manifestations. Confirmed diagnosis of breast NF is based on the combination of clinical, cultural, laboratory, and imaging findings. Urgent subsequent treatments, including surgical debridement, antibiotic therapy, and reconstructive surgery, are critical for better prognosis and survival of patients.
坏死性筋膜炎（NF）是一种罕见的、迅速进展的、潜在致命的组织感染，涉及皮下组织、浅筋膜和覆盖的皮肤。由于皮肤和深筋膜之间有厚厚的乳房组织，乳房 NF 经常被误诊。只有早期诊断，随后及时进行抗生素治疗和手术治疗，才能防止灾难性后果。有许多关于乳房 NF 的病例报告，但缺乏系统评价。我们使用 PubMed 和 Scopus 对 20 年来的文献进行了系统回顾。我们回顾了有潜在合并症（危险因素）、触发因素、实验室检查、培养物、抗生素治疗、手术干预、脓毒性休克存在和最终结果的文章。我们还对所有这些因素与死亡的关系进行了统计学检验。从 38 篇文章中确定了 40 例病例纳入我们的文献复习。21 例（52.5%）为原发性，15 例（37.5%）发生在手术后。在 15 例（37.5%）中，单一病原体引起 NF，而在 17 例（42.5%）中发现混合病原体。39 例（97.5%）进行了手术清创。所有 5 例（12.5%）死亡病例均发现脓毒性休克，并与患者死亡率相关（p<0.001）。乳房 NF 是一种罕见的、严重的、易误诊的并发症。乳房 NF 在病因模式和临床表现上可能与其他身体部位不同。乳房 NF 的确诊基于临床、文化、实验室和影像学发现的综合。紧急后续治疗，包括手术清创、抗生素治疗和重建手术，对改善患者的预后和生存至关重要。
