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A case report of primary necrotising fasciitis of the breast: A rare but deadly entity requiring rapid surgical management

View Article: PubMed Central - PubMed

ABSTRACT

Primary necrotising fasciitis of the breast is an extremely rare entity.

We present the youngest patient described in the literature.

Prompt resuscitation and surgical intervention are critical to successful management.

Prompt resuscitation and surgical intervention are critical to successful management.

No MeSH data available.


Related in: MedlinePlus

Appearance of the breast preoperatively, showing a large area of ulceration.
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fig0010: Appearance of the breast preoperatively, showing a large area of ulceration.

Mentions: Over the next few hours, the patient received 5 L of intravenous crystalloid resuscitation along with inotropic support, including boluses of metaraminol (2 mg total) and adrenaline (1.1 mg total). She remained anuric during this time. A noradrenaline infusion was commenced in ED via a central line, with a peak pre-operative rate of 1.5 mg/h. With advice from ICU, a vasopressin infusion was also commenced at 4 units/h. In light of a reported possible penicillin allergy, renal-adjusted doses of IV meropenem, IV clindamycin and IV vancomycin were administered after consultation with the infection control team. The patient was taken to the operating theatre within 3 h of her presentation and underwent an emergency right mastectomy and debridement of all necrotic tissue including pectoralis major fascia, preserving pectoralis major. A haematologist was consulted with regard to the patient’s coagulopathy and 2 units of fresh frozen plasma were administered intraoperatively to prevent excessive haemorrhage. The wound was packed and covered with a vacuum assisted closure (VAC) dressing, and the patient was transferred to the intensive care unit for post-operative care where she remained intubated and sedated. Continuous renal replacement therapy (CRRT) was commenced Fig. 1, Fig. 2, Fig. 3, Fig. 4, Fig. 5 .


A case report of primary necrotising fasciitis of the breast: A rare but deadly entity requiring rapid surgical management
Appearance of the breast preoperatively, showing a large area of ulceration.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5304239&req=5

fig0010: Appearance of the breast preoperatively, showing a large area of ulceration.
Mentions: Over the next few hours, the patient received 5 L of intravenous crystalloid resuscitation along with inotropic support, including boluses of metaraminol (2 mg total) and adrenaline (1.1 mg total). She remained anuric during this time. A noradrenaline infusion was commenced in ED via a central line, with a peak pre-operative rate of 1.5 mg/h. With advice from ICU, a vasopressin infusion was also commenced at 4 units/h. In light of a reported possible penicillin allergy, renal-adjusted doses of IV meropenem, IV clindamycin and IV vancomycin were administered after consultation with the infection control team. The patient was taken to the operating theatre within 3 h of her presentation and underwent an emergency right mastectomy and debridement of all necrotic tissue including pectoralis major fascia, preserving pectoralis major. A haematologist was consulted with regard to the patient’s coagulopathy and 2 units of fresh frozen plasma were administered intraoperatively to prevent excessive haemorrhage. The wound was packed and covered with a vacuum assisted closure (VAC) dressing, and the patient was transferred to the intensive care unit for post-operative care where she remained intubated and sedated. Continuous renal replacement therapy (CRRT) was commenced Fig. 1, Fig. 2, Fig. 3, Fig. 4, Fig. 5 .

View Article: PubMed Central - PubMed

ABSTRACT

Primary necrotising fasciitis of the breast is an extremely rare entity.

We present the youngest patient described in the literature.

Prompt resuscitation and surgical intervention are critical to successful management.

Prompt resuscitation and surgical intervention are critical to successful management.

No MeSH data available.


Related in: MedlinePlus