Abstract
Necrotizing fasciitis is a life and limb threatening soft tissue infection with a high mortality rate. This study tries to identify the possible risk factors that contribute to mortality in patients with necrotizing fasciitis involving a lower limb. We prospectively reviewed 41 patients that presented with necrotizing fasciitis of the lower limb over a period of one year. Results show that the mortality rate for necrotizing fasciitis of the lower limb is quite high at 19.5%. Comparison among necrotizing fasciitis patients reveals that higher mortality rate is seen among those patients with advanced age and those presented with initial high pre-operative creatinine levels. Sex, pre-morbid diabetes mellitus, duration from initial symptoms to presentation for treatment and presence of streptococcus group A were not associated with an increased mortality rate. Neither were admission vital signs, subcutaneous gas on radiograph, prior antibiotic treatment on admission or clinical note of bullae formation.
Highlights
Necrotizing fasciitis is an uncommon but potentially limb and life threatening soft tissue infection
This study looks into the risk factors involving the lower limbs
This was a prospective study of risk factors for mortality in patients diagnosed with necrotizing fasciitis of a lower limb
Summary
Necrotizing fasciitis is an uncommon but potentially limb and life threatening soft tissue infection. It has been recognized clinically since the time of Hippocrates 1 , and first documented in modern surgical literature by Joseph Jones as “hospital gangrene” 2. Diagnosis was made by combination of clinical and gross anatomical findings during surgery We excluded those patients in which treatment were performed in other hospitals and transferred in for further management and those who took part in at-own-risk discharge or transferred out to other hospitals pre- or post-treatment. Culture and sensitivities were taken from the infected wound during the debridement or amputation to test for Strep group A organisms. Antibiotics were adjusted as soon as the culture and sensitivity results were available
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