LIMB SALVAGE FOR STREPTOCOCCAL GANGRENE OF THE EXTREMITY

BACKGROUND: Extremity soft tissue infections from group A, beta-hemoly tic streptococcus frequently culminate in amputation. This study compa res our protocol for limb salvage with expected results. METHODS: Pati ents with extremity streptococcal gangrene treated from 1989 to 1995 w ere reviewed. The management protocol mandated immediate, radical exci sion of involved skin and subcutaneous tissue, with preservation of fa scia. Patients were managed in the burn unit, and wounds were covered with split-thickness skin grafts. Amputation rate and mortality were m easured. RESULTS: Fourteen cases of extremity streptococcal gangrene w ere identified. Delay to surgical referral was 5 days. Eleven (79%) pa tients were septic. Ten (71%) were managed with a single debridement b efore grafting. Limb salvage was 93% (13 of 14). One patient (7%) died on day 150 from acute myelogenous leukemia. CONCLUSIONS: Delay in ref erral of extremity streptococcal gangrene is common, contributing to a high incidence of sepsis. Our management protocol of a single, radica l debridement with preservation of fascia maximizes limb salvage and s urvival. (C) 1998 by Excerpta Medica, Inc.