Necrotizing soft-tissue infections: our experience at rural tertiary care centre

Abstract

Background: Necrotizing soft-tissue infections are infection of any of the layers within the soft tissue compartment that are associated with necrotizing changes. These infections are highly lethal if not diagnosed. The purpose of this article is to assess the different diagnostic tools. Methods: We carried out a retrospective study to assess the prevalence of soft tissue infections at Geetanjali medical college and hospital, Udaipur (Tertiary care rural centre) in last four years. Clinical details of the 216 patients with soft tissue infection were recorded from their case sheets and were analyzed with reference to their age, sex, risk factor, symptoms, etiology, microbiology, treatment employed, complication and final outcome etc. Results: Pain and swelling were commonest presenting symptoms found in every case. Diabetes and Trauma were major predisposing factor in our series. NSTI differ from NNSTI with respect to presence of blister (50% versus 5.8%), Dusky discoloration (58.3% versus 0%), Necrotic skin (51.04% versus 0% ) and Crepitance (6.2% versus 0%). In present series’ most common organism causing NSTI in our institute is gram negative bacilli .Prompt resuscitation followed by early and adequate debridement remains the cornerstone of management of NSTI. Conclusions: Diagnosis of necrotizing infection is challenging but there are enough tools including clinical findings, biochemical parameters, imaging aids and invasive procedures that can help make the diagnosis. When in doubt, exploration of the compromised tissue should be performed. The mainstay of treatment is early and adequate surgical debridement.