OUR EXPERIENCE IN DIAGNOSIS AND TREATMENT OF NECROTIZING FASCIITIS

Abstract

Background: Necrotizing fasciitis (NF) is a severe, relatively rare and potentially deadly infection, which is usually caused by one or two pathogenic microorganisms. The target areas that are affected are the skin and the subcutaneous tissues of the lower and the upper limbs, the scrotum, the perineal region (Fournier gangrene) and the abdominal wall. The early diagnosis and aggressive surgical treatment are of great importance for the outcome of this potentially lethal disease. 
 Methods: Eleven patients with diagnosis of NF had been treated in the Clinic of Plastic and Reconstructive surgery of St. George Hospital, Plovdiv for a five-year period (2013-2018). Based on the demographic, clinical and laboratory data the presurgical, the following surgical treatment, and the postsurgical management were analyzed.
 Results: The mean age of the patients was 58.7 years (median: 56 years, range 37–87 years) and 75% were men. Old age (above 65 years) and female gender correlated significantly with lethality. Most often the regions affected were the perineum and the scrotum (46.8%), followed by lower limbs (35.5%), upper limbs and abdominal wall (8.1%). Diabetes mellitus, oncologic diseases, alcohol addiction and chronic hepatic and renal diseases were found to be predisposing factors for development of NF. We started treatment with broad spectrum antibiotics, early and vigorous drainage and meticulous debridement with wide excision of the damaged tissues. Vacuum therapy was applied as part of the treatment of the defects. It allowed continuous wound cleaning and accelerated formation of granulation tissue, followed by definite closure of the defect.
 Conclusion: The diagnosis of NF needs adequate proceedings and treatment of the cases among surgeons as its clinical presentation is unspecific. The prompt surgical debridement and excision is the mainstay in the treatment of all patients and repeated surgical excisions are required. Plastic surgery is an undeniable stage in the complex treatment of NF regarding the large size of the wound and necessity of definite closure of the soft tissue defects.