NECROTIZING FASCIITIS OF THE UPPER EXTREMITY

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.