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Background <p>Necrotizing fasciitis (NF) is a rare, rapidly progressive soft tissue infection with high morbidity and mortality, if not recognized and treated promptly. While NF typically involves the lower limbs, trunk, or perineum, hand involvement is uncommon, and thumb involvement is exceptionally rare. NF of the hand carries a significant risk of limb loss, with reported amputation rates up to 28%. Early diagnosis, aggressive debridement, and timely reconstruction are essential for functional recovery.</p> Case presentation <p>We present a 40-year-old male with newly diagnosed type 2 diabetes mellitus who developed severe pain, swelling, and necrosis of the left thumb and hand after drainage of a thumb abscess. Examination revealed extensive necrosis, swelling, crepitus, and loss of thumb function. Imaging showed gas-forming infection, and laboratory studies confirmed systemic inflammation. Emergency debridement and carpal tunnel release were performed, but progression necessitated thumb amputation at the metacarpophalangeal joint and excision of necrotic tissues. Cultures identified Streptococcus constellatus, Streptococcus agalactiae, and anaerobes. Reconstruction was staged with a free anterolateral thigh flap and tendon transfer, followed by a pedicled ulnar artery perforator flap. After a 34-day hospitalization, the patient achieved good healing with viable flaps.</p> Conclusion <p>Thumb NF is extremely rare but devastating, particularly in diabetic patients with polymicrobial infections. Subtle early signs may mask deep tissue spread. Prompt surgical debridement, multidisciplinary care, and staged reconstruction are critical to optimize outcomes. This case underscores the importance of early recognition, aggressive intervention, and timely reconstruction in preserving hand function in thumb NF.</p>

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Necrotizing fasciitis of the thumb reconstructed with a free flap: a case report and review of surgical lessons

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月20日

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  • Mohamed Badie Ahmed,
  • Fatima Saoud Al-Mohannadi,
  • Faissal Al Zeir,
  • Mazin Mohammed,
  • Shiyas Mohammedali,
  • Jing Qin Tay,
  • Abeer Alsherawi

摘要

Background

Necrotizing fasciitis (NF) is a rare, rapidly progressive soft tissue infection with high morbidity and mortality, if not recognized and treated promptly. While NF typically involves the lower limbs, trunk, or perineum, hand involvement is uncommon, and thumb involvement is exceptionally rare. NF of the hand carries a significant risk of limb loss, with reported amputation rates up to 28%. Early diagnosis, aggressive debridement, and timely reconstruction are essential for functional recovery.

Case presentation

We present a 40-year-old male with newly diagnosed type 2 diabetes mellitus who developed severe pain, swelling, and necrosis of the left thumb and hand after drainage of a thumb abscess. Examination revealed extensive necrosis, swelling, crepitus, and loss of thumb function. Imaging showed gas-forming infection, and laboratory studies confirmed systemic inflammation. Emergency debridement and carpal tunnel release were performed, but progression necessitated thumb amputation at the metacarpophalangeal joint and excision of necrotic tissues. Cultures identified Streptococcus constellatus, Streptococcus agalactiae, and anaerobes. Reconstruction was staged with a free anterolateral thigh flap and tendon transfer, followed by a pedicled ulnar artery perforator flap. After a 34-day hospitalization, the patient achieved good healing with viable flaps.

Conclusion

Thumb NF is extremely rare but devastating, particularly in diabetic patients with polymicrobial infections. Subtle early signs may mask deep tissue spread. Prompt surgical debridement, multidisciplinary care, and staged reconstruction are critical to optimize outcomes. This case underscores the importance of early recognition, aggressive intervention, and timely reconstruction in preserving hand function in thumb NF.