title: Fatal Necrotizing Fasciitis following Episiotomy.
abstract: Introduction. Necrotizing fasciitis is an uncommon condition in general practice but one that provokes serious morbidity. It is characterized by widespread fascial necrosis with relative sparing of skin and underlying muscle. Herein, we report a fatal case of necrotizing fasciitis in a young healthy woman after episiotomy. Case Report. A 17-year-old primigravida underwent a vaginal delivery with mediolateral episiotomy. Necrotizing fasciitis was diagnosed on the 5th postpartum day, when the patient was referred to our tertiary care medical center. Surgical debridement was initiated together with antibiotics and followed by hyperbaric oxygen therapy. The patient died due to septic shock after 16 hours from the referral. Conclusion. Delay of diagnosis and consequently the surgical debridement were most likely the reasons for maternal death. In puerperal period, a physician must consider necrotizing fasciitis as a possible diagnosis in any local sings of infection especially when accompanied by fever and/or tenderness. Early diagnosis is the key for low mortality and morbidity.
authors.affiliation: Department of Plastic Surgery, Hand Surgery and Burn Center, Faculty of Medicine, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany.
authors.forename: Faris
authors.initials: F
authors.lastname: Almarzouqi
authors.affiliation: Department of Plastic Surgery, Hand Surgery and Burn Center, Faculty of Medicine, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany.
authors.forename: Gerrit
authors.initials: G
authors.lastname: Grieb
authors.affiliation: Department of General, Visceral and Transplant Surgery, Faculty of Medicine, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Klink
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Bauerschlag
authors.affiliation: Department of Plastic Surgery, Hand Surgery and Burn Center, Faculty of Medicine, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany ; Department of Plastic and Reconstructive Surgery, Hand Surgery and Burn Care Center, Cologne-Merheim Medical Center, University of Witten/Herdecke, Ostmerheimer Straße 200, 51109 Cologne, Germany.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Fuchs
authors.affiliation: Department of Plastic Surgery, Hand Surgery and Burn Center, Faculty of Medicine, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany.
authors.forename: Ziyad
authors.initials: Z
authors.lastname: Alharbi
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany.
authors.forename: Marketa
authors.initials: M
authors.lastname: Vasku
authors.affiliation: Department of Plastic Surgery, Hand Surgery and Burn Center, Faculty of Medicine, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Pallua