On the first day, the patient received two treatments of HBO therapy, followed by one treatment per day. HBO was given at 2.8 ATA for 90 minutes per day. In this case we needed five serial debridements to stabilize the wound. The results of microbiological

analysis of the lower AW and retroperitoneal space showed a polymicrobial infection with Escerichia coli, Psudomonas aeruginosa, and Streptococcus fecalis, Streptococcus pyogenes, and the presence of mixed anaerobes, including Bacteroides fragilis and Clostridum spp. Blood cultures were positive for Escerichia coli and Pseudomonas aeruginosa. Methicillin-resistant Staphylococcus aureus (MRSA) was present Ruxolitinib mw in the second blood culture. Two weeks after the initial operation, the AW became stable and fresh granulation tissue appeared. At that point, we started closing the defects by using local advancement flaps, regenerative tissue matrix, and skin grafts. The closure of the diverting colostomy was performed three months postoperatively when the anterior abdominal has been strongly reinforced with a dermal matrix that was incorporated under the skin flaps. During long term follow up the colostomy was completely PF2341066 closed and regular bowel function was restored. Incidence and classification Necrotizing fasciitis,

the most complicated and life threatening NSTI, has a progressive and rapidly advancing clinical course [1]. Although occurring in all age groups, NF is slightly more common in older age groups (> 50

years of age) [2]. The infection usually affects the deep fascial plane, with secondary necrosis of subcutaneous tissue and skin caused by the thrombosis of the subcutaneous and perforators vessels. The incidence of NF has been reported to be 0.40 cases per 100 000 adults [3]. There is a male to female ratio of 3:1 in all cases of NSTI, which relates predominately to the oxyclozanide incidence of Fournier’s gangrene of the perineum [3]. The terminology used for infections of skin and skin structures is often confusing. Skin and soft tissue infections (SSTIs) are best classified according to the anatomical site of infection, depth of infection, microbial source of infection, or by severity (minor superficial lesion to invasive, fulminant and even lethal infections) (Table 2.). The Infection Disease Society of America made practical classification of SSTIs into three groups: superficial, uncomplicated infection (includes impetigo, erysipelas and cellulitis), necrotizing infection; infections associated with bites and animal contact; surgical site infections and infections in the immunocompromised host [3]. The recent clinical classification distinguished four NF types: Type I (70-80%, polymicrobial/synergistic), type II (20% of cases; usually monomicrobial), type III (gram-negative monomicrobial, including marine-related organisms) and type IV (fungal) [1].