NECROTIZING FASCIITIS OF THE VULVA

At the Department of Surgery of the Medical University Lubeck, 25 case s of necrotising fasciitis (NF) were treated between 01.05.1990 and 30 .04.1995. 6 cases originated from the vulva, the perineum or the anore ctal region. The mean age in this group was 70.6 years. 5 of the 6 pat ients suffered from insulin-dependent diabetes mellitus. Mixed infecti ons consisting of facultative and obligate anaerobes were found in 5 c ases, 22 debridements were performed (i.e. 3.8 per patient). 6 of the 25 patients died (24.6%). 5 of the patients with NF of the vulva had a fatal course (83.3%). The reasons for the higher mortality are the hi gher mean age in the female group as compared with the total amount of patients (70.6 vs 59.7 years) and the longer delay between the onset of symptoms and operative treatment (6.5 vs. 4.2 days). Female patient s older than 60 years suffering from diabetes mellitus are a high risk group for developing NF. An early and aggressive debridement with pro grammed daily revisions must be performed to stop the foudroyant cours e of the disease. An adequate surgical therapy should be supported by intensive care treatment and administration of appropiate antibiotics.