DOI: http://dx.doi.org/10.18203/2349-2902.isj20185479

Necrotizing fasciitis: a tertiary centre based study

Nishith M. Paul Ekka, Archana Dipa Sangita Kujur, Gaurav Mishra

Abstract


Background: Necrotizing fasciitis is a limb or life-threatening, invasive soft-tissue infection, although known since ancient times was first described in 1871. The purpose of the present study is to analyze the clinical presentation, bacterial flora, predisposing and co-morbid conditions, surgical and resuscitative treatment and outcome of this soft tissue infection.

Methods: This is a prospective, cross-sectional, clinical study which was conducted from May 2016 until April 2018. This study included 60 consecutive patients. Age, gender, clinical presentation, co-morbid conditions and predisposing factors and pus culture sensitivity, treatment given, and its outcome were recorded.

Results: With a male female ratio of 2.33:1 and median age of 46, most involves site was lower limb. Most patients presented with history of trauma followed by swelling (100%), pain (91.67%), and pus discharge (48.33%). Group A streptococcus was the most common organism isolated in both monomicrobial (53.85%) and polymicrobial (63.83%) cultures. Diabetes was the most common co morbidity observed. Fasciotomy and debridement were the mainstay of treatment with amputation rate of 23.33% and a mortality of 25%.

Conclusions: Timely surgical intervention in the form of fasciotomy and debridement along with correction of malnutrition and anemia can be crucial in saving lives and limbs.


Keywords


Cellulitis, Gangrene, Infection, Necrotizing fasciitis

Full Text:

PDF

References


Decamps V, Atiken J, Lee MG. Hippocrates on necrotizing fasciitis. Lancet. 1994 Aug 20;344(8921):556.

Bosshardt TL, Henderson VJ, Organ CH. Necrotizing soft-tissue infections. Arch Surgy. 1996 Aug 1;131(8):846-54.

Wilson B. Necrotizing fasciitis. Am J Surg. 1952;18:416-31.

Kotrappa KS, Bansal RS, Amin NM. Necrotizing fasciitis. Am Fam Physician. 1996;53(5):1691-7.

Ardire L. Necrotizing fasciitis: case study of a nursing dilemma. Ostomy Wound Manage. 1997;43(5):30-4.

Harmonson JK, Lobar MY, Harkless LB. Necrotizing fasciitis. Clin Podiatr Med Surg. 1996;13(4):635-46.

Espandar R, Sibdari SY, Rafiee E, Yazdanian S. Necrotizing fasciitis of the extremities: a prospective study. Strategies Trauma Limb Reconstr. 2011 Nov;6(3):121-5.

Muqim R. Necrotizing fasciitis: Management and Outcome. J Coll Physicians Surg Pak. 2003 Dec;13(12):711-4.

Khamnuan P, Chongruksut W, Jearwattanakanok K, Patumanond J, Tantraworasin A. Necrotizing fasciitis: epidemiology and clinical predictors for amputation. Int J General Med. 2015;8:195-202.

Shaikh N. Necrotizing fasciitis: a decade of surgical intensive care experience. Indian J Critical Care Med. 2006 Oct 1;10(4):225-9.

Stone HH, Martin Jr JD. Synergistic necrotizing cellulitis. Ann Surg. 1972 May;175(5):702-11.

Singh G, Bharpoda P, Reddy R. Necrotizing fasciitis: a study of 48 cases. Indian J Surg. 2015 Dec 1;77(2):345-50.

Peer SM, Rodrigues G, Kumar S, Khan SA. A clinicopathological study of necrotizing fasciitis--an institutional experience. J Coll Physicians Surg Pak. 2007 May;17(5):257-60.

Angoules AG, Kontakis G, Drakoulakis E, Vrentzos G, Granick MS, Giannoudis PV. Necrotising fasciitis of upper and lower limb: a systematic review. Injury. 2007 Dec 1;38(5):S18-25.

Elliott DC, Kufera JA, Myers RA. Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Ann Surg. 1996 Nov;224(5):672-83.

Kwan MK, Saw A, Chee EK, Lee CS, Lim CH, Zulkifle NA, et al. Necrotizing fasciitis of the lower limb: an outcome study of surgical treatment. Med J Malaysia. 2006 Feb;61:17-20.

Cheng NC, Tai HC, Chang SC, Chang CH, Lai HS. Necrotizing fasciitis in patients with diabetes mellitus: clinical characteristics and risk factors for mortality. BMC Infectious Dis. 2015 Dec;15(1):417.