Necrotizing Fasciitis After Plastibell Circumcision

Abstract

Necrotizing fasciitis is a potentially life-threatening infection of subcutaneous tissues and Scarpa's fascia that rarely affect neonates. We report the occurrence of this devastating infection in two neonates after routine Plastibell circumcision. These case reports highlight the presentation and management of this complication after a relatively routine and frequently performed operation. This report also emphasizes the differences between cellulitis and necrotizing fasciitis and suggests strategies for management. (J Pediatr 1997;131:459-462) Necrotizing fasciitis is a surgical emergency resulting from infection of the subcutaneous tissue and superficial fascia by a variety of bacteria. In the neonatal age group it may have a mortality rate greater than 70% 1 Successful treatment requires accurate diagnosis with early and aggressive debridement of the involved tissue, broad-spectrum intravenous antibiotic coverage, and intensive support care. We report two cases in newborn male infants in whom necrotizing fasciitis developed after Plastibell (Hollister, Libertyville, Ill.) circumcision. These cases illustrate the devastating nature of this type of infection and show how aggressive treatment can lead to a satisfactory outcome. CASE REPORTS