STANDARDIZED THERAPY OF NECROTIZING FASCI ITIS

Summ.: From the file online at the department of surgery of the Medica l University Lubeck, 894 patients with soft tissue infections treated between 01. 05. 90 and 31. 12. 94 were evaluated. 21 cases (10 men, 11 women) were classified as necrotizing fasciitis (i.e. 2.2%). The mean age was 59.7 years (range 17-84 years). Frequent predisposing disease s were diabetes mellitus (n=12) and lower extremity ischemia (n = 8) a nd alcoholism (n = 4). The causing injuries were of minor nature (n = 11), crural ulcers (n = 3) and abscesses caused by intramuscular injec tion (n = 3). In 7 cases Streptococcus pyogenes group A was responsibl e for the infection. Different pathogen germs were found in 14 patient s. The first essential steps to treat the patient are aggressive surgi cal debridement and programmed daily revisions. 76 debridements were p erformed (3.6 per patient). Amputations were necessary in 4 cases. Int ensive care treatment and the administration of antibiotics support th is surgical therapy. Meshgraft transplantation (n = 18) and secondary suture (n = 11) were done when wound conditions were suitable for it. 4 patients died (19%). An increased mortality was found in patients ol der than 65 years (36.4%) and if operative treatment was performed mor e than 5 days from the beginning of symptoms (33.3%). An early diagnos is and standardized treatment lead to better results in terms of morta lity and preservation of the infected limb and its function.