BACKGROUND: Necrotizing soft tissue infections (NSTI) are increasing, posing a significant risk of morbidity and mortality. Due to nonspecific symptoms, a high index of suspicion is crucial. Treatment involves a multidisciplinary approach, with broad-spectrum antibiotics, early surgical debridement, and life support. This study analyzes the characteristics, demographics, complications, and treatment of NSTI in a hospital in Madrid, Spain.
METHODS: A retrospective observational study was conducted, including all surgically treated NSTI patients at our center from January 2016 to December 2022, examining epidemiological and clinical data. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) was prospectively calculated for all patients.
RESULTS: Twenty-two patients (16 men, 6 women, mean age 54.8) were included. Median time from symptom onset to emergency room visit was 3.5 days. All reported severe treatment-resistant pain; sixteen had fever exceeding 37.8°C (72.7%). Skin lesions occurred in twelve (54.5%), and thirteen had hypotension and tachycardia (59.1%). Treatment involved resuscitative support, antibiotherapy, and radical debridement. Median time to surgery was 8.25h. Intraoperative cultures were positive in twenty patients: twelve Streptococcus pyogenes, four Staphylococcus aureus, one Escherichia coli, and four polymicrobial infection. In-hospital mortality rate was 22.73%.
CONCLUSIONS: We examined the correlation between our results, amputation rates and mortality with LRINEC score and time to surgery. However, we found no significant relationship unlike some other studies. Nevertheless, a multidisciplinary approach with radical debridement and antibiotic therapy remains the treatment cornerstone. Our hospital stays, outcomes and mortality rates align with our literature review, confirming high morbimortality despite early and appropriate intervention.

OBJECTIVE: Chronic graft-versus-host disease (cGVRD) is a systemic immune-mediated complication that occurs in approximately half of the patients undergoing allogeneic haematopoietic stem cell transplantation (allo-HCT) and, although it is associated with beneficial graft versus tumour effects and lower relapse rates, it remains the leading cause of late morbidity and mortality in these patients. The aim of this systematic review of the literature is to provide a current overview on the diagnostic musculoskeletal manifestations of cGVRD, its clinical evaluation, and therapeutic possibilities.
METHODS: We ran a systematic search in PubMed, Embase, and Cochrane Library. Studies from the last 20 years were included. Priority was given to cross-sectional studies to evaluate diagnostic methods and to clinical trials in the case of articles referring to treatment. The search was limited to humans and articles published in English or Spanish.
RESULTS: We identified 6423 studies, of which we selected 86 (37 on clinical and diagnostic evaluation and 49 on treatments). Specific studies on fascial and joint complications are scarce and of low quality, including only isolated clinical cases or case series. Fasciitis is the most relevant musculoskeletal manifestation, and isolated joint involvement is low, sometimes unnoticed and underdiagnosed, if a thorough exploration of joint motion is not performed. Early detection of cGVRD with fascial and/or joint involvement requires careful and repeated evaluation.
CONCLUSIONS: The search for new biomarkers or advanced imaging techniques that allow early diagnosis is necessary. Physiotherapy is essential to improve functionality and prevent disease progression. Controlled studies are needed to establish recommendations on second lines of treatment. Because of its multisystemic nature, cGVRD requires a multidisciplinary approach.

There is no consensus about the role of adjunctive hyperbaric oxygen therapy (HBOT) in the management of Fournier\'s gangrene. The aim of this study was to compare the evolution of patients with Fournier\'s gangrene treated with all classical measures with and without adjuvant HBOT. A retrospective comparative study regarding the evolution of patients treated for Fournier\'s gangrene was conducted in two periods. In period I, from 1990 to 2002, patients received standard treatments for Fournier\'s gangrene, which consisted of surgical debridement, antibiotic therapy and intensive care. In period II, from 2012 to 2019, adjunctive HBOT was added to the classical management strategy. All patients were assigned into four groups according to the anatomical severity classification and the area affected after the first debridement. This classification ensured that the groups could be comparable. The total number of patients in this study was 197, and these patients were divided into control group (118/59.9%) and HBOT group (79/40.1%). The mean age, comorbidities, and anatomical severity classification were similar between the two groups. In period I, 34 out of 118 (28.8%) patients died, while in the HBOT group, 3 out of 77 (3.7%) patients died (P < 0.001). The use of adjuvant HBOT in combination with classical treatment was associated with reduced mortality. This study was approved by the Institutional Review Board and the Ethics Committee of Ribeirão Preto Medical School, University of São Paulo, Brazil (No. 08/2018) on May 2, 2018.

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BACKGROUND: Multifocal necrotizing fasciitis is a condition in which there is more than one non-contiguous body area affected, and it is usually the result of the dissemination of septic emboli.
METHODS: We present a 67 year-old patient, on oral corticosteroid treatment, who was admitted with a septic shock. The previous week he had been operated on due to the perforation of a colon diverticulum. He had signs that suggested necrotizing fasciitis on all four limbs which progressed quickly. Emergency fasciotomies on all limbs were performed, and empirical antibiotic treatment was started.
RESULTS: After the surgery the patient improved, and seven days after the debridement, primary closure of the wounds was performed. Tissue cultures were negative.
CONCLUSIONS: Being a rare entity, there is no consensus regarding the management of multifocal necrotizing fasciitis. However, early and aggressive debridement (including fasciotomies and even amputation) and broad-spectrum antibiotics are essential for its treatment.