Twelve cases of necrotizing fasciitis were identified retrospectively
over a 5-year period. All were associated with a history of substance
abuse by injection or with diabetes. Eleven of the 12 infections were
associated with beta-hemolytic Streptococcus, a mixed anaerobic aerobi
c infection, or both. Three of five patients tested for human immunode
ficiency virus had positive test results. A wide extensile approach wa
s used to debride necrotic fascia. An average of 3 debridements were n
ecessary, with a range of 1-6 debridements. Two patients underwent sho
ulder disarticulation because of uncontrollable infection. The rapid a
nd destructive nature of this disease makes early recognition, aggress
ive debridement, and antibiotic therapy necessary to minimize morbidit
y.