David D Zabel, MD, FACS
Tertiary Hospital Over a Four-Year Period in China
Deep neck infections (DNIs) are a group of serious bacterial infections occurring in the potential spaces and fascia of the neck. The incidence of DNIs is not clear. Although many studies have shown that the incidence of DNIs has decreased due to the use of antibiotics and improvements in sanitary conditions, reports also indicate an increased incidence of DNIs in the last 10 years. Deep neck multiple-space infections (DNMIs) are the most serious among all types of DNIs and often spread further to cause mediastinal infections, invade the carotid sheath, and possibly compromise the airway, resulting in life-threatening conditions.
Treatments for DNMIs include life-supporting measures, surgical drainage, and appropriate use of antibiotics. Among these treatments, surgical drainage is key. Although traditional extensive surgical drainage is effective for treating DNMIs, some limitations remain for this approach, ie, drainage depends on gravity, the locations for the drainage tube and incision are limited, dressing changes and wound irrigation more than once a day may increase patient suffering, and secondary wound infection may occur. In recent years, vacuum-assisted closure (VAC)
The Risk of Fournier’s Gangrene Leading to Mortality and Irreversible Organ Damage
The efficacy of surgical intervention for perianal infection in patients with hematologic malignancy is not well-established. Objective. This article presents a case series of perianal infection progressing to Fournier’s gangrene (FG) in patients with hematologic malignancy to guide physicians, because to the author’s knowledge, there were no randomized or prospective studies presenting the management strategies reported herein. It was hypothesized that surgery might reduce mortality and morbidity in patients with inflammation spreading beyond the perianal region, in patients with abscess formation, and in those who show no improvement with medical therapy. Materials and Methods. The data of 4 adults with hematologic malignancy who developed perianal infection progressing to FG between January 2010 and December 2018 were reviewed retrospectively … read more
A man bitten on the leg by a 7-foot shark quickly gets treatment for his wounds. A week later, he suffers from excruciating pain brought about by flesh-eating bacteria.
In early August, Blaine Shelton from Texas was swimming at Crystal Beach in Houston when he spotted a fin, which he immediately knew was not from a friendly porpoise. He was reportedly about 200 yards from the shore, so he began swimming to get away from the shark. It was then that he was bitten on the thigh, just above his knee. Shelton was able to swim ashore after the bite and was immediately taken to the hospital to be treated for his wounds. He later learns that the shark attack was likely from a 7-foot bull shark … read more
Dr. John Crew from Seton Medical Center is interviewed by CBS Bay Area news
for using NeutroPhase® as an effective cleanser for a necrotizing fasciitis infection.
The National Necrotizing Fasciitis Foundation (NNFF), a 501c3 non-profit organization that seeks to raise public awareness of Necrotizing Fasciitis and offer support for those affected, is encouraging a new approach to treating necrotizing infections. The treatment and the referral initiative are crucial advances in the fight against this deadly threat, says Jacqueline Roemmele, executive director of the NNFF. Roemmele co-founded the organization in 1997 with fellow survivor, Donna Batdorff of Grand Rapids, Michigan, after her own years-long struggle with the disease and its aftermath, to offer information and emotional support to other patients and their families.
This approach calls for the use of NeutroPhase® Skin and Wound Cleanser in conjunction with Negative Pressure Wound Therapy. For the physicians who have utilized NeutroPhase with NPWT, not one of their patients has required amputation or suffered loss of life. As the late Dr. Crew described in a paper in the journal WOUNDS, NeutroPhase has been shown in laboratory testing to not only kill the bacteria that are known to be present in NF wounds, but also to neutralize the toxins produced by those bacteria. Unless they are neutralized, those toxins continue to destroy tissue even if the bacteria have been killed, explaining why so many patients lose body parts. Dr. Crew extrapolated from those laboratory results to try the NeutroPhase on patients with NF. “No one I’ve been responsible for treating has lost an arm or leg, or a life,” said Dr. Crew. “We have something that will change the standard of care for this terrible disease.”
NeutroPhase, an FDA cleared 510(k) medical device, is the only skin and wound cleanser with a patented and pure form of hypochlorous acid (HOCl) that doesn’t contain bleach impurities. HOCl is produced by white blood cells as a first defense against microbial invaders. Lab tests show that, in solution, HOCl not only kills bacteria, it also neutralizes the toxins that kill tissue.
The NNFF is a founded in 1997 by two survivors of Necrotizing Fasciitis. The NNFF’s mission is to educate and raise public awareness of NF symptoms and preventative measures, to advocate research, and to offer support for those affected by necrotizing fasciitis. The NNFF supports a hotline where patients suffering from Necrotizing Fasciitis can get support from physicians familiar with treating NF and NeutroPhase to help save their limbs and lives.
- More information on The National Necrotizing Fasciitis Foundation can be found at www.nnff.com or call 908-422-7744
- More information on NeutroPhase can be found at www.neutrophaseus.com
- Treatment of Acute Necrotizing Fasciitis Using Negative Pressure Wound Therapy and Adjunctive NeutroPhase Irrigation Under the Foam
- Flow-through Instillation of Hypochlorous Acid in the Treatment of Necrotizing Fasciitis
- Dr. Kerry Thibodeaux on NeutroPhase (video)
Abstract: Introduction. Necrotizing fasciitis (NF) is a rare and rapidly progressing bacterial infection of soft tissues. Bacterial toxins cause local tissue damage and necrosis, as well as blunt immune system responses. A self-propagating cycle of bacterial invasion, toxin release and tissue destruction can continue until substantial amounts of tissue become necrotic. Neutralization of bacterial toxins should improve the results.
Materials and Methods. Pure hypochlorous acid (HOCl) (0.01% w/v) with no sodium hypochlorite impurity in saline pH 4-5, which was recently shown to both eradicate bacteria and neutralize bacterial toxins in vitro, was administered via flow-through instillation to 6 patients with NF 4-6 times daily as needed. Utilizing a vacuum-assisted closure, 5-10 mL of pure 0.01% HOCl with no sodium hypochlorite impurity was instilled and removed frequently to irrigate the wounds. Results. Of the 6 patients, no deaths or limb amputations occurred. All infected areas healed completely without major complications. Conclusion. The toxicity and immune dysfunction caused by bacterial toxins and toxins released from damaged cells may be mitigated by flow-through instillation with saline containing pure 0.01% HOCl with no sodium hypochlorite impurity. Randomized controlled clinical trial research of this relatively simple and inexpensive instillation protocol is suggested for identified cases of NF.
Necrotizing fasciitis (NF), commonly referred to in nonmedical discourse as “flesh-eating” inflammation, is a rapidly progressing involvement of the fascia and subcutaneous tissues that can subsequently extend to the muscles and skin. Type I NF is classified as a polymicrobial infection, whereas type II NF is classified as a monomicrobial infection.1 Bacterial toxins released during the course of necrotic inflammations produce direct cytotoxic effects on surrounding tissues, while also causing immune system dysfunction and localized immunosuppression. The authors’ new therapy incorporates the use of an instillation vacuum-assisted closure procedure, also known as negative pressure wound therapy (NPWT), with pure 0.01% hypochlorous acid (HOCl) with no sodium hypochlorite—commonly known as bleach—impurity.2 As pure 0.01% HOCl (ie, > 97% relative molar distribution of active chlorine species as HOCl) in a 0.9% saline solution at pH 4-5 has been shown to both rapidly kill bacteria and neutralize bacterial toxins in vitro, clinical administration of pure HOCl with no sodium hypochlorite impurity was recently explored … read more