Outcomes of Management of Necrotizing Soft Tissue- Infections in Lower Limbs of Diabetic Patients

Abstract

Necrotizing soft tissue infection (NSTI) of the lower limb in diabetic patients (pts) is a common serious problem and is often associated with serious complications such as increased morbidity and mortality. The study aimed to assess 3 years (yrs) experience of NSTI and to review treatment and outcome in diabetic pts at Al Thoura Teaching Hospital between May 1ST 2014 –30th April 2017, over a period of 3 yrs.24 cases of NSTI of lower limbs in diabetic pts were admittedin the period of MAY 1ST 2014 –30th April 2017. Assessment and analyzing details about their presentation, clinical features, predisposing factors, treatment offered, and outcomes were performed .16 male and 8 female pts with a mean age of 56.4 yrs (range of 39- 78 yrs) were included . Majority of patients were in the age group of 50 to 70 yrs. The most important risk factors were (glycosylated HbA1c > 9.5% in 91.66%), smoking (58.33%), hypertension and hyperlipidemia (66.66% & 83.33% respectively). Neuropathy was found in 62.5% and PVD in 50%. The total involved feet are 27. The port of infection was mostly by previous unhealed feet ulcer 48.1%. The most operated surgical procedure is aggressive frequent necrectomy (51%). Multiple toes amputations and extended tarsal amputation were needed in 29.6% and 20.8% respectively. The need for grafting, flap advancement after surgical control of infection was needed in 6 cases. The failure rate of conservative surgery was 11.11%. Complete healing was in 70.37% of cases. The morbidity rate was high in all patients in this study 92.59%. The mortality rate was 3.7%. We conclude that NSTI of lower limbs is a life-threatening infective condition, common among diabetic patients, and early diagnosis with immediate and frequent surgical debridement could reduce systemic complications, morbidity, and mortality considerably.