{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T18:20:03Z","timestamp":1788286803888,"version":"build-2803163510"},"reference-count":12,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Necrotizing soft tissue infections of the breast are exceptionally rare surgical emergencies with high mortality, and monomicrobial Escherichia coli (Type 3) necrotizing fasciitis is an uncommon, highly virulent form. We report a 23-year-old woman with insulin-treated Type 1 diabetes mellitus as her only comorbidity who developed extensive breast necrosis from a small pustule and presented with sepsis. Wound cultures were sterile while blood cultures grew E. coli. She underwent repeated debridement, sequential vacuum-assisted closure therapy and, after infection control, latissimus dorsi myocutaneous flap reconstruction, followed by revision for partial lateral flap necrosis, and was discharged in good condition. Even a minor skin breach in a diabetic patient may trigger fulminant gram-negative necrotizing fasciitis; early recognition, aggressive debridement, culture-guided antibiotherapy, vacuum-assisted closure, and staged flap reconstruction are critical for survival and functional recovery.<\/jats:p>","DOI":"10.1093\/jscr\/rjag770","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T11:39:05Z","timestamp":1787053145000},"source":"Crossref","is-referenced-by-count":0,"title":["From pustule to flap: necrotizing fasciitis of the breast in type 1 diabetes\u2014a case report"],"prefix":"10.1093","volume":"2026","author":[{"given":"Emre","family":"Tun\u00e7","sequence":"first","affiliation":[{"name":"Department of Surgical Oncology, \u015eanl\u0131urfa Mehmet Akif \u0130nan Training and Research Hospital , Esentepe Mah., Ertu\u011frul Cad., 308. Sok. No: 32A, 63040 Haliliye, \u015eanl\u0131urfa ,","place":["T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6kke\u015f","family":"\u00c7imen","sequence":"additional","affiliation":[{"name":"Department of Plastic, Aesthetic and Reconstructive Surgery, \u015eanl\u0131urfa Mehmet Akif \u0130nan Training and Research Hospital , Esentepe Mah., Ertu\u011frul Cad., 308. Sok. No: 32A, 63040 Haliliye, \u015eanl\u0131urfa ,","place":["T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"key":"2026090114122174500_ref1","doi-asserted-by":"publisher","first-page":"e19886","DOI":"10.7759\/cureus.19886","article-title":"Necrotizing fasciitis of the breast requiring a life-saving mastectomy: a case report and literature review","volume":"13","author":"Islam","year":"2021","journal-title":"Cureus"},{"key":"2026090114122174500_ref2","doi-asserted-by":"publisher","author":"Zhou","DOI":"10.1093\/burnst\/tkaf031"},{"key":"2026090114122174500_ref3","doi-asserted-by":"publisher","first-page":"109147","DOI":"10.1016\/j.ijscr.2023.109147","article-title":"Uncommon presentation of necrotizing fasciitis affecting the breast in a young breastfeeding patient","volume":"114","author":"Benlghazi","year":"2024","journal-title":"Int J Surg Case Rep"},{"key":"2026090114122174500_ref4","doi-asserted-by":"publisher","first-page":"3731779","DOI":"10.1155\/crdi\/3731779","article-title":"Bacterial synergism in breast necrotizing fasciitis: a case report on diagnostic dilemmas, therapeutic challenges, and reconstructive management","volume":"2025","author":"Essid","year":"2025","journal-title":"Case Rep Dermatol Med"},{"key":"2026090114122174500_ref5","doi-asserted-by":"publisher","DOI":"10.3390\/medicina57101072"},{"key":"2026090114122174500_ref6","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.ijid.2023.05.011","article-title":"High mortality risk of type III monomicrobial gram-negative necrotizing fasciitis: the role of ExPEC and Klebsiella pneumoniae","volume":"134","author":"Chen","year":"2023","journal-title":"Int J Infect Dis"},{"key":"2026090114122174500_ref7","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1186\/s13018-023-03561-7","article-title":"Vacuum-assisted closure versus conventional dressing in necrotizing fasciitis: a systematic review and meta-analysis","volume":"18","author":"Zhang","year":"2023","journal-title":"J Orthop Surg Res"},{"key":"2026090114122174500_ref8","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1007\/s00404-023-07186-3","article-title":"Latissimus dorsi flap for breast reconstruction: a large single-institution evaluation of surgical outcome and complications","volume":"309","author":"Banys-Paluchowski","year":"2024","journal-title":"Arch Gynecol Obstet"},{"key":"2026090114122174500_ref9","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1055\/a-2045-8122","article-title":"Systematic review of patient-reported outcomes and complications of pedicled latissimus flap breast reconstruction","volume":"50","author":"Peshel","year":"2023","journal-title":"J Reconstr Microsurg"},{"key":"2026090114122174500_ref10","doi-asserted-by":"publisher","first-page":"rjad230","DOI":"10.1093\/jscr\/rjad230","article-title":"Necrotizing fasciitis of the breast after bilateral breast reduction","volume":"2023","author":"Borg","year":"2023","journal-title":"J Surg Case Rep"},{"key":"2026090114122174500_ref11","doi-asserted-by":"publisher","first-page":"e75298","DOI":"10.7759\/cureus.75298","article-title":"Monomicrobial gram-negative necrotizing fasciitis of the lower extremity","volume":"16","author":"Suleman","year":"2024","journal-title":"Cureus"},{"key":"2026090114122174500_ref12","doi-asserted-by":"publisher","first-page":"169","DOI":"10.3233\/CH-238119","article-title":"Pathogens and their resistance behavior in necrotizing fasciitis","volume":"86","author":"Br\u00e9bant","year":"2024","journal-title":"Clin Hemorheol Microcirc"}],"container-title":["Journal of Surgical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2026\/9\/rjag770\/70895510\/rjag770.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2026\/9\/rjag770\/70895510\/rjag770.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T18:12:28Z","timestamp":1788286348000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jscr\/article\/doi\/10.1093\/jscr\/rjag770\/8778701"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,31]]},"references-count":12,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,8,31]]}},"URL":"https:\/\/doi.org\/10.1093\/jscr\/rjag770","relation":{},"ISSN":["2042-8812"],"issn-type":[{"value":"2042-8812","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,9]]},"published":{"date-parts":[[2026,8,31]]},"article-number":"rjag770"}}