1) The document summarizes a presentation on a skin-sparing approach to treating necrotizing fasciitis in children.
2) Key aspects of the approach include early and wide debridement of non-viable tissues while preserving viable skin, with a median skin to fascia excision ratio of 0.1.
3) Using this approach in 13 patients, there was no mortality and low morbidity, with no patients requiring skin grafting and a median time to closure of 5 days.
DETAILED DISCUSSION OF NECROTIZING FASCIITIS.
A SOFT TISSUE INFECTION. USUALLY CALLED AS FLESH EATING BACTERIAL INFECTION. CAUSED BY BACTERIA. AFFECTS THE SOFT SKIN TISSUES
NECROTISING FASCIITIS- the flesh eating infection
#surgicaleducator #necrotisingfasciitis #surgicaltutor #babysurgeon #usmle
· Dear Viewers
· Greetings from “Surgical Educator”
· Today in this episode I have discussed about Necrotising Fasciitis- the flesh eating infection
· It is common in immunocompromised patients even after trivial trauma.
· I have discussed about the overview,etiology,types,clinical features,complications and treatment of Necrotising Fasciitis
· I hope this video is interesting and also useful to all of you
· You can watch the video in the following links:
· surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
Thank you for watching the video
DETAILED DISCUSSION OF NECROTIZING FASCIITIS.
A SOFT TISSUE INFECTION. USUALLY CALLED AS FLESH EATING BACTERIAL INFECTION. CAUSED BY BACTERIA. AFFECTS THE SOFT SKIN TISSUES
NECROTISING FASCIITIS- the flesh eating infection
#surgicaleducator #necrotisingfasciitis #surgicaltutor #babysurgeon #usmle
· Dear Viewers
· Greetings from “Surgical Educator”
· Today in this episode I have discussed about Necrotising Fasciitis- the flesh eating infection
· It is common in immunocompromised patients even after trivial trauma.
· I have discussed about the overview,etiology,types,clinical features,complications and treatment of Necrotising Fasciitis
· I hope this video is interesting and also useful to all of you
· You can watch the video in the following links:
· surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
Thank you for watching the video
Debridement is an important component of the wound bed preparation (WBP) management Model.
Cause of the wound and patient-centered concerns, debridement is a necessary step in local wound care.
Debridement is the removal of necrotic tissue, exudate, bacteria, and metabolic waste from a wound in order to improve or facilitate the healing process
Include infections of skin, subcutaneous tissue, fascia, and muscle, encompass a wide spectrum of clinical presentations, ranging from simple cellulitis to rapidly progressive necrotizing fasciitis.
Diagnosing the exact extent of the disease is critical for successful management of a patient of soft tissue infection
Debridement is an important component of the wound bed preparation (WBP) management Model.
Cause of the wound and patient-centered concerns, debridement is a necessary step in local wound care.
Debridement is the removal of necrotic tissue, exudate, bacteria, and metabolic waste from a wound in order to improve or facilitate the healing process
Include infections of skin, subcutaneous tissue, fascia, and muscle, encompass a wide spectrum of clinical presentations, ranging from simple cellulitis to rapidly progressive necrotizing fasciitis.
Diagnosing the exact extent of the disease is critical for successful management of a patient of soft tissue infection
Compartment Sydrome: A Sports Medicine Physician's PerspectiveDr. David Carfagno
Compartment syndrome is a complication that patients experience following fractures (most common cause), soft tissue trauma, or reperfusion injuries, which leads to arterial obstruction and muscle swelling. This presentation was given to the physicans at Banner Health in Feburary 2014 by David Carfagno, DO, of Scottsdale Sports Medicine
A case presentation requiring wide debridement and a trephine defunctioning colostomy with operative finding photos. Includes how to diagnose and manage this potentially fatal condition.
To learn more about diabetic foot wounds visit my website
www.healmyfootwoundfast.com
Educational power point on foot wounds relating to:
1. Obesity in America
2. The Epidemic of Diabetes
3. Complications of Diabetes
4. Cost Realities of Diabetes
5. Chronic Foot Ulcers
Dr. Donald Pelto
299 Lincoln Street Suite 202
Worcester, MA 01605
•Recognize patients at risk for diabetic foot infections
•Design a diagnostic work-up for diabetic foot osteomyelitis
•State the principles of management of diabetic foot infections
Middle east respiratory syndrome: humans and healthcare facilitiesIan M. Mackay, Ph.D
Slides from my invited presentation to the zoonosis session of the International Congress for Tropical Medicine and Malaria (ICTMM), 18-22 September, 2016
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
La costante tentazione dei trattamenti ipofrazionati: breve cronistoria dei modelli biologici e degli effetti clinici
•Recognize patients at risk for diabetic foot infections
•Design a diagnostic work-up for diabetic foot osteomyelitis
•State the principles of management of diabetic foot infections
Merkel Cell Carcinoma: From Diagnosis to Treatment (webinar)Natalie Richardson
Merkel Cell Carcinoma: From Diagnosis to Treatment ~ view the webinar recording on our youTube channel: https://youtu.be/vIcrzSTabKw
Hear Dr. Marco Iafolla, Medical Oncologist at William Osler Health System, review the latest news, clinical data and other updates as they relate to the treatment of merkel cell carcinoma (MCC). Dr. Iafolla provides an update on the science behind primary and metastatic MCC diagnosis, an overview of the disease features, staging and prognostication, surgery and treatment options including immuno-oncology for MCC, and the impact of all of this to patients. (Rec. Nov. 27, 2019)
Video at https://www.youtube.com/watch?v=f8HRluqOqDg
🙈🙉🙊
We discuss the clinical features on the basis of a case series from the U.K. and then have a Q&A with pox virologist and UpToDate author on the topic, Dr. Stuart Isaacs.
Discussant: Stuart N. Isaacs, MD; Perelman School of Medicine at the University of Pennsylvania
Host: Benjamin P. Geisler, MD MPH
Recording date: May 30, 2022
0:00 Intro
1:09 Outline and Study Type
2:13 Background
5:31 Case Series
11:39 Q&A w/ Dr. Isaacs
References:
-Case series: Adler H et al. Lancet ID online early doi: 10.1016/S1473-3099(22)00228-6
-Comparison to Covid-19 case report/series: Rothe C et al N Engl J Med. 382(10); 970-1 doi: 10.1056/NEJMc2001468 https://pubmed.ncbi.nlm.nih.gov/32003...
-Dr. Isaac’s UpToDate article:
-Microbe.TV: This Week in Virology (TWiV) Special: Monkeypox clinical update with Dr. Daniel Griffin https://www.youtube.com/watch?v=dMiT7...
-Program for Monitoring Emerging Diseases (ProMED) Monkeypox update (06), 30 May 2022: https://promedmail.org/
-Centre for Infectious Disease Research and Policy (CIDRAP): WHO says monkeypox containable, but nations should be on alert. https://www.cidrap.umn.edu/news-persp...
-Phylogenetic trees: Hendrickson RC et al. Viruses 2010(2); 1933-67. doi: 10.3201/eid2409.171283 https://pubmed.ncbi.nlm.nih.gov/30124...
-Virion schematics: ViralZone, from https://commons.wikimedia.org/wiki/Fi...
-Discussion of on-going MPXV genome sequencing: https://virological.org/t/discussion-...
-Genomic epidemiology of monkeypox virus: https://nextstrain.org/monkeypox?l=clock
#monkeypox #virus
"What Will It Take To Control TB?" Richard Chaisson, MDUWGlobalHealth
Dr. Richard Chaisson, Professor of Medicine, Epidemiology and International Health and Director of the Center for Tuberculosis Research at the Johns Hopkins University in Baltimore was the keynote Jan. 19 as part of the Washington Global Health Discovery Series. His talk was on ""What Will It Take To Control TB?"
Hallie Prescott tells us about why the back-end of sepsis matters and is a neglected aspect of our management. This sub-acute phase can really affect long term outcomes. Long term exposure to broad-spectrum antibiotics and too much fluid are aspects that matter and that we can modify.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
1. University Center of Pediatric Surgery of Western Switzerland
Pediatric Plastic Surgery - Division of Pediatric Surgery
University of Geneva Children’s Hospital
A skin-sparing
approach to necrotizing fasciitis
Giorgio La Scala, MD, PD, FMH(CH)
WUWHS 5th Congress
Florence, September 25-29, 2016
3. History
•“... If such an accident was
neglected in the slightest
degree ... great inflammation
took place, and the erysipelas
quickly spread all over ... and
there were great fallings off of
the flesh, tendons, and bones;
and the defluxion which
seated in the part was not like
pus, but a sort of putrefaction
...”
Hippocrates. Of the Epidemics, vol. 2 sect. 3 par. 4 (Translated by Francis Adams)
9. Laboratory Risk Indicator for Necrotizing Fasciitis
(LRINEC) score – for adults
Variable, Unit Score
CRP, mg/L
<150 0
≥150 4
WBC, G/L
<15 0
15–25 1
>25 2
Hemoglobin, g/L
>135 0
110-135 1
<110 2
Variable, Unit Score
Sodium, mmol/L
≥135 0
<135 2
Creatinine, µmol/L
≤141 0
>141 2
Glucose, mmol/L
≤10 0
>10 1
≥ 6 Suspected fasciitis
≥ 8 Highly predictive of fasciitis
Wong, Khin et al., Critical Care Medicine 2004;32:1535-41
10. Final diagnosis: histopathology
•Superficial fascia necrosis
•Polymorphonuclear WBC in deep dermis and fascia
•Fascial arteries and vein fibrinous thrombosis
•Angiitis with arterial and venous walls fibrinoid necrosis
•Bacteria on Gram’s stain of fascia and dermis
•No muscle involvement
Stamenkovic & Lew. N Engl J Med 1984, 310:1689-93
13. Management
•IV Antibiotics
•Wide spectrum antibiotics
•Co-Amoxicillin 50 mg/kg/dose max 2.2 g q6h
•Clindamycin 15 mg/kg, then 10 mg/kg max 600 mg q8h
•If suspected MRSA add Vancomycin 15 mg/kg max 500 mg q6h
•IV Fluids
•Ringer Acetate 20 ml/kg
14. Management
•Emergency surgery
•Diagnosis (frozen sections)
•Wide debridement
•Early surgery: decreases morbidity and mortality
Wong, Khin et al. Crit Care Med 2004, 32:1535-41
Sarani, Strong et al. J Am Coll Surg 2009, 208:279-88
22. Surgery
•Excision of clearly necrotic skin, extended incisions as necessary
•Headlamp, 2.5 × loupes, long retractors
•Deep wound swabs for bacterial cultures and PCR
•Excision until
•Active bleeding
•Glistening fascia adhering to surrounding planes
•Healthy-looking adipose tissue
•Normal marginal biopsies (frozen sections)
23. Management
•Negative pressure wound therapy
•Hyperbaric oxygen if extensive undermining or skin ischemia
•Second look at 24-48h with repeated biopsies as necessary
•Closure when skin and wound well vascularized
•Suction drainage
•Compressive dressing
24. Patients
•2008-2016: n=13; 7 girls, 6 boys
•Incidence (Geneva) 1.4 : 100’000 children ≤ 16 years old
•Median age 4.8 year (1.7-15.1)
•Symptoms duration prior to consultation: 24h (12-72)
•Admission to surgery interval: 6h (1-30)
•Symptoms duration prior to surgery: 49.5h (15-77)
44. Conclusions
•High index of suspicion
•Excruciating pain
•Chickenpox
•Early debridement of non-viable tissues
•Skin preservation is possible
•Median skin to fascia excision ratio: 0.1 (0.03-0.5)
46. Prevention
•USA: Varicella vaccination program (CDC)
•Two doses, at 12-15 months and 4-6 years
•Canada: Public funded vaccine program since 2004
•114 (2005-2009) annual hospitalizations from 288 (1999 to 2004)
•Switzerland: Recommended in children > 11 years without chickenpox Hx
•Annual hospitalizations of varicella ≈100 (4 × Canada)
Holmes, Reef et al. MMWR Recomm Rep 1996, 45:1-36
Marin, Güris et al. MMWR Recomm Rep 2007, 56:1-40
Varicella-Public Health Agency of Canada, 2012-07-23 (http://tinyurl.com/hclartf)
Bonhoeffer & Heininger. Paediatrica 2008, 19:48-50
47. Prevention
•Varicella vaccination program (CDC)
•Two doses, at 12-15 months and 4-6 years
•Second dose catch-up vaccination for those having received 1 dose only
•Routine vaccination of healthy ≥ 13 years old without immunity
•...
Holmes, Reef et al. MMWR Recomm Rep 1996, 45:1-36
Marin, Güris et al. MMWR Recomm Rep 2007, 56:1-40
48. Prevention (Canada)
•Public funded vaccine programs since 2004
•Annual hospitalizations of varicella down to 114 (2005-2009) from 288 (1999 to 2004)
“Varicella increases the risk of severe invasive group A streptococcal
infection in previously healthy children by 40- to 60-fold”
Varicella-Public Health Agency of Canada, 2012-07-23 (http://tinyurl.com/hclartf)
49. Prevention (Switzerland)
•Recommended for children > 11 years without history of chickenpox
•Annual hospitalizations of varicella ≈100 (4 × Canada)
“the 2% of adults infected with chickenpox have
16 × the complications and 20-40 × the mortality compared to children.”
Bonhoeffer & Heininger. Paediatrica 2008, 19:48-50
50. Publication
•Rüfenacht MS, Montaruli E, Chappuis E, Posfay-Barbe KM, La Scala GC.
•Skin-Sparing Débridement for Necrotizing Fasciitis in Children.
•Plast Reconstr Surg. September 2016; 138: 489e-97e.
51. Giorgio La Scala, MD, PD, FMH(CH)
University Center of Pediatric Surgery of Western Switzerland
Pediatric Plastic Surgery - Division of Pediatric Surgery
University of Geneva Children’s Hospital
giorgio.lascala@hcuge.ch