NECROTIZING SOFT-TISSUE INFECTIONS - OBSTACLES IN DIAGNOSIS

BACKGROUND: This study was done to identify obstacles in the early dia gnosis and treatment of necrotizing soft tissue infections. STUDY DESI GN A ten-year retrospective case series was analyzed. RESULTS: Data fr om 29 patients were analyzed. Among patients undergoing early operatio n within 24 hours of admission (n=17) there was one death (6 percent m ortality rate); survivors averaged 2.9 operations per patient. By comp arison, of patients with delayed operation (n=12) three died (25 perce nt mortality rate) and there were 3.6 operations per patient. Positive fine-needle aspiration (FNA) of suspicious lesions, demonstrating eit her pus or bacteria by Gram's stain, led to early operation in 80 perc ent of patients tested. Patients with soft tissue gas on radiographs w ere more likely to undergo early operation (58 percent). Delayed opera tion was more common in the absence of radiographic findings. All pati ents admitted to nonsurgical services had delayed operations. CONCLUSI ONS: Suspected necrotizing soft tissue infections require prompt surgi cal evaluation and early operative exploration. Early operation with d efinitive surgical therapy initiated within 24 hours of admission is a ssociated with decreased mortality rates. Negative FNA findings, nondi agnostic radiographs, and admission to a nonsurgical service correlate with delay in definitive operative intervention.