<< Back to the abstract archive
Management of Primary Necrotizing Fasciitis of the Breast - A Systematic Review
Ryan D. Konik, MD
Gregory S. Huang, MD
Hospital center training program
2018-01-31
Presenter: Ryan D. Konik, MD
Affidavit:
All of the work included in this abstract represents the original work of the resident.
Director Name: Ronald A. Rhodes, MD, FACS
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Purpose:
Necrotizing fasciitis (NF) is a life-threatening infection involving spreading necrosis of the subcutaneous tissue and fascia that affects the extremities, abdominal wall and perineum. Primary infection of the breast is a rare occurrence. Shah et al. described the first case of primary breast NF and recommended radical 'pseudotumor' excision and delayed skin closure months after resolution. Numerous cases reported have been successfully managed with different strategies. We aimed to summarize management guidelines of primary breast NF through a systematic review of the literature.
Methods:
A systematic review of English literature was performed using PubMed. A total of 51 abstracts were reviewed. Data was abstracted from 21 cases that met inclusion criteria.
Results:
A total of 32 cases of breast NF were found in the literature with 21 cases of primary infections without an inciting event. Common initial operations included excisional debridement (33.3%), total mastectomy (33.3%), partial mastectomy (9.5%) and debridement with nipple areolar complex preservation (9.5%). A total or radical mastectomy was completed for definitive infection control in 11 cases (52.4%). A total of 17 cases underwent reconstruction. Split-thickness skin grafts (41.2%) and delayed primary closures (35.3%) were the most common repairs.
Conclusion:
Majority of primary breast NF cases are managed with a total mastectomy to gain source control. Reconstruction using split thickness skin grafts was common. Other options include delayed primary closure, full thickness skin grafts, local tissue rearrangement and TRAM flap reconstruction. Reconstruction should be patient dependent.
