In everyday surgical practice infections that are life threatening conditions and which require early recognition and aggressive surgical debridement along with broad spectrum antibiotics therapy, are rare. When NF becomes a rapidly progressing necrosis of the subcutaneous fat and fascia,

it develops into a life threatening disease that needs prompt recognition, extensive debridement, immediate antibiotic therapy and intensive care treatment. Early and aggressive surgery is mandatory for establishing the JQEZ5 right diagnosis as well as for removing as much infected tissue as possible in a single operation. The diagnosis remains primarily clinical, but diagnostic adjuncts such as LRINEC scoring system can be useful for early and precise diagnosis [5]. Different types of microorganisms can cause NF. As seen in our clinical study, the majority of cases begin with an existing infection, most frequently on the extremities, in the perineum or on the AW. As previously stressed, the treatment

modalities of NF in different patient groups are very heterogeneous, but the most important factor of mortality is the time of operative intervention, as well as the number of co-morbidities [36]. Patients with DM appear to be particularly at risk, representing over 70% of cases in one large review [46]. The other co-morbidities include obesity, alcohol abuse, immune-deficiency, chronic renal failure, liver cirrhosis, hypertension, peripheral vascular disease and age above 60 years [1, 2]. In cases where the diagnosis is uncertain, repeated clinical GDC 973 assessment and multiple vectors approach integrating a range of diagnostic PI3K inhibitor modalities will optimize the final diagnosis [1]. MG-132 cell line Many physicians today are not familiar enough with NSTI and NF to proceed rapidly with an accurate diagnosis and the necessary management [36]. The majority of cases today are treated on an outpatient basis or in outpatient clinics. On the other hand, each untreated necrotizing infection or a misdiagnosed case has a poor prognosis and severe course. In highly suspicious cases of necrotizing infections a multidisciplinary team approach is mandatory, involving the GP doctor, general and plastic surgeons, radiologists,

microbiologists, physiotherapists and nutritionists. In the majority of clinical cases, surgeons have a high responsibility level for timely and appropriate surgical treatment and therefore the final outcome. Thus, early surgical debridement, combined with broad spectrum antibiotics, intensive care therapy and adjuvant HBO therapy should become part of the “”Treatment doctrine for NSTI and NF”", as well as for the treatment of clostridial myonecrosis [36]. Patient Consent Written informed consent was obtained from the patients for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. References 1. Morgan MS: Diagnosis and management of necrotizing fasciitis: A multiparametric approach.