Necrotizing fasciitis. Role of early surgical intervention
Qazi, S.A.; Mohammed, A.A.; Saber, E.I.; Mirza, S.M.
Saudi Medical Journal 25(7): 890-894
2004
ISSN/ISBN: 0379-5284 PMID: 15235695 Document Number: 569634
Objective: To evaluate our experience of management of necrotizing fasciitis (NF) particularly the role of early and aggressive surgical intervention. Methods: This is a retrospective review of the cases affected by this disease and managed at Riyadh Medical Complex, Riyadh, Kingdom of Saudi Arabia, during 5 calendar years from 1996 through to 2000 (1416-1420 A.H). The preoperative and operative data was collected, and postoperative morbidity and mortality were analyzed. Results: A total of 25 cases of NF were treated during the 5-year period, 18 were males and 7 female. The majority of patients had perianal suppuration as the primary lesion, followed by groin area in drug addicts and only 2 cases were primarily in the upper limbs. Diabetes and drug addiction were the main predisposing factors. All but 3 infections were polymicrobial, with streptococci and acinobacter being the most frequent organisms. The mainstay of treatment depends on a high index of suspicion, aggressive early and repeated debridements and adequate antibiotic coverage. The overall mortality was 24% but the drastic reduction in mortality was observed with early surgical intervention. Conclusion: The results highlight the role of early diagnosis; prompt and aggressive surgical debridements are critical for improved survival.