Necrotizing Fasciitis: A Vicious Soft Tissue Infection: Review Article

Abstract

Background: Necrotizing fasciitis is rapidly progressive, lethaldestructive inflammation with polymicrobialinfection and secondary necrosis. Though it is a disease described from the Hippocratic era, there is an increase inthe incidence of necrotizing fasciitis. The most important factors determining the outcome of the disease are earlydiagnosis and aggressive debridement.Materials and Methods: Cross-sectional descriptive study was conducted in a tertiary care teaching hospital’ssurgical ward. A total of 50 patients, diagnosed with necrotizing fasciitis based on the criteria set were includedin the study. After detailed clinical and laboratory evaluation, appropriate and adequate surgical and medicalinterventions were administered and were followed to note the outcome.Results: The majority of patients were over 40 years old and 74% of them were male. 72% of them had fever, 88% ofthem had tenderness. 68% of the patients had involvement of the lower extremities. Trauma was the predominanttriggering factor and diabetes, the most commonly associated predisposing disease present in 72% of patients.84% of the infections were polymicrobial and E. coli was isolated from 74% of them. 4 patients succumbed to thedisease and 6 patients needed amputations as a life-saving measure. Acidosis and hypoalbuminemia were themost common independent predictive factors for mortality. Once sepsis is overcome and the granulation tissue isformed, the wound is covered with an SSG or flap cover.Conclusion: The aggressive and destructive course of necrotizing fasciitis could lead to morbidity and mortality.Early recognition, aggressive debridement are the essential steps for recovery. Though broad-spectrum antibioticsstarted as empirical therapy to avoid the catastrophe of septic shock, appropriate antibiotics should be started asthe disease is often polymicrobial. Acidosis, truncallocation, leucocytosis and decreased albumin were found to befactors strongly associated with mortality.