Abstract
Necrotizing fasciitis (NF) is a group of relatively rare infections, usually caused by two or more pathogens. It affects the skin and subcutaneous tissues of lower and upper limbs, perineal area (Fournier's gangrene), and the abdominal wall. Early diagnosis and aggressive surgical management are of high significance for the management of this potentially lethal disease. We conducted a retrospective study in patients who presented, during the last decade, at four University Surgical Departments in the area of Athens, Greece, with an admission diagnosis of NF. Demographic, clinical, and laboratory data were gathered, and the preoperative and surgical treatment, as well as the postoperative treatment was analyzed for these patients. A total of 62 patients were included in the study. The mean age of patients was 63.7 (47 male patients). Advanced age (over 65 years) (P < 0.01) and female sex (P = 0.04) correlated significantly with mortality. Perineum was the mostly infected site (46.8%), followed by the lower limbs (35.5%), the upper limbs, and the axillary region (8.1%). Diabetes mellitus was the most common coexisting disease (40.3%), followed by hypertension (25.8%) and obesity (17.7%). The most common symptom was local pain and tenderness (90.3%). Septic shock occurred in eight patients (12.9%) and strongly correlated with mortality (P < 0.01). Laboratory data were used to calculate the LRINEC score of every patient retrospectively; 26 patients (41.9%) had LRINEC score under 6, 20 patients (32.3%) had LRINEC score 6-8, and 16 patients (25.8%) had LRINEC score >9. Surgical debridement was performed in all patients (mean number of repeated debridement 4.8), and in 16 cases (25.8%) the infected limb was amputated. The mean length of hospital stay was 19.7 days, and the overall mortality rate of our series was 17.7%. Diagnosis of NF requires high suspect among clinicians, as its clinical image is non-specific. Laboratory tests can depict the severity of the disease; therefore, they must be carefully evaluated. Urgent surgical debridement is the mainstay of treatment in all patients; the need of repetitive surgical debridement is undisputed.
Highlights
Necrotizing fasciitis (NF) is a group of relatively uncommon, but life-threatening infections, which have the same clinical course and require urgent treatment
NF is sometimes falsely called as “gas gangrene” due to free gas accumulating in the soft tissue spaces, giving the characteristic image of gas gangrene on plain X-rays and computed tomography (CT) scans [3]; this term describes only the third type of NF, where the infection is caused mainly by Clostridium species
Advanced age is widely accepted as a prognostic factor for NF, it is currently uncertain whether sex may influence NF clinical course and outcome
Summary
Necrotizing fasciitis (NF) is a group of relatively uncommon, but life-threatening infections, which have the same clinical course and require urgent treatment. It usually affects the skin, soft tissues, and muscles, and may progress rapidly through the fascia planes, resulting in gradual destruction of the fascia. The most frequent comorbidity is diabetes mellitus, which can be found in 40–60% of patients with any NF type [4] It is under consideration whether diabetes mellitus is correlated with worse outcome or not [5, 6]. Necrotizing fasciitis (NF) is a group of relatively rare infections, usually caused by two or more pathogens It affects the skin and subcutaneous tissues of lower and upper limbs, perineal area (Fournier’s gangrene), and the abdominal wall. Diagnosis and aggressive surgical management are of high significance for the management of this potentially lethal disease
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