NECROTIZING FASCIITIS - AN INDICATION FOR HYPERBARIC OXYGENATION THERAPY

Background. The accepted treatment protocol for necrotizing fasciitis (NF) consists of extensive surgery and wide spectrum antibiotics. Hype rbaric oxygenation (HBO) has been recommended as adjuvant therapy for NF, improving patient mortality and outcome. However, the beneficial e ffect of HBO for NF remains controversial. Methods. A retrospective ev aluation of treatment outcome in 37 patients treated for NF between 19 84 and 1993 was carried out. The mortality rate, morbidity criteria, a nd risk factors for grave prognosis were compared between a group of 2 5 patients who received HBO as part of their treatment protocol and a group of the remaining 12 patients treated by surgical excision and an tibiotics alone. Results. The two groups were found to be similar with regard to age, gender, the Incidence of individual risk factors for o minous prognosis, and the Acute Physiology and Chronic Health Evaluati on (APACHE) II score for disease's severity on presentation. The morta lity rate among the HBO-treated patients was 36%, as opposed to 25% in the non-HBO group. The mean number of surgical debridements required per patient was significantly higher in the HBO group: 3.3 compared wi th 1.5 in the non-HBO-treated patients. Although the average length of hospitalization for survivors was shorter for the HBO group, the diff erence between the groups did not reach statistical significance. Conc lusions. The results of this study cast doubt on the suggested advanta ge of HBO in reducing patient mortality and morbidity when used as adj uvant therapy for NF.