Necrotizing fasciitis is a rapidly progressive soft tissue infection extending from the skin to the fascia, resulting in extensive necrosis. It is a very rare but serious complication, with mortality ranging from 10 to 15%. Optimal management involves early diagnosis followed by treatment combining antibiotic therapy and wide surgical removal as soon as possible. Localisation in the breast is uncommon. Although most cases are primary necrotizing fasciitis of the breast, several cases of necrotizing fasciitis have been reported in the post-operative aftermath of breast surgery. We present a case of necrotizing fasciitis of the breast following submammary mastectomy with immediate reconstruction using a pre-pectoral silicone implant, which resulted in multiple organ failure and the death of the patient despite optimal medical and surgical management. This is the first case to occur after immediate breast reconstruction.

BACKGROUND: Surgical tourism is a growing phenomenon, causing a surge demand for the management of its complications. In this study, we aimed to evaluate complications that occur after cosmetic breast surgery abroad; and their costs for the public health system.
METHODS: We reviewed the medical files of patients treated in our department for a complication after cosmetic breast surgery outside Switzerland and assessed all complications requiring hospitalization; and estimated the overall medical costs.
RESULTS: Over a two-year period, 26 patients were treated for 39 complications. The main complication was infection (71% of cases), mainly with a multidrug-resistant organism (47%) and atypical mycobacteria. Of the 16 patients with breast prosthesis, 7 implants were removed. The effective average costs incurred for the hospital care of these cases was estimated to 14\'724 Swiss Francs (∼12\'963 Euros) per patient.
CONCLUSIONS: The high rate of multidrug-resistant and mycobacterial atypical infections are a major public health problem. It is necessary to inform patients much better about the risks of surgical tourism. Furthermore, the danger of transfer of multidrug-resistant or atypical germs from abroad should not be overlooked. Physicians should be informed about this risk and take necessary measures for treatment and diagnosis of these complications.

OBJECTIVE: To compare the effect of antibiotics prophylaxis within 30 mins before skin incision (A) and after umbilical cord clamping (C) on the incidence of postoperative infections in patients undergoing elective caesarean section at Farhat Hached university teaching hospital.
METHODS: We conducted a randomised clinical trial evaluating 279 patients undergoing elective caesarean section. Patients were randomly assigned a group number that allocated them to either arm of the study. They received the same prophylactic antibiotic (cefazol® 2g) according to their allotment. They were followed up to detect infection up to 30 days postoperatively. The primary outcome was postoperative infection. The data collected were analysed with SPSS version 18.0 using univariate and bivariate analysis.
RESULTS: The risk of overall postoperative infection was not significantly lower when prophylaxis was given before skin incision (4.37 % (A) vs 9.85 % (C); P=0.07; OR=0.42 [0.15-1.12]). We also found wound infections to be significantly reduced in the pre-incision group (2.2 % [A] vs 8.45 % [C]; P=0.03; OR=0.24 [0.06-0.88]). However, there was no difference in the endometritis infectious. On the other hand, there was no negative impact on the neonatal features.
CONCLUSIONS: Giving prophylactic antibiotics before skin incision reduces risk of postoperative infection, in particular of wound infections.