POSTPARTUM AND VULVAR NECROTIZING FASCIITIS - EARLY CLINICAL-DIAGNOSIS AND HISTOPATHOLOGIC CORRELATION

OBJECTIVE: To review the clinical course and correlate histopathologic findings of obstetrics and gynecology patients with necrotizing fasci itis. STUDY DESIGN: Seventeen patients with postpartum or vulvar necro tizing fasciitis were identified from 1981 to 1996. Medical records we re retrospectively reviewed. Information was available for all patient s until death or discharge from the hospital. Histopathologic material on 15 patients was available for review. RESULTS: Five postpartum pat ients were diagnosed and surgically debrided one to nine days after ce sarean delivery, with no mortality. Twelve patients with vulvar necrot izing fasciitis were diagnosed and surgically debrided <1-10 days afte r presentation to a physician, with three deaths (25%). On histopathol ogic review, all crises had prominent lobular and septal panniculitis. Thirteen cases had histologic evidence of fasciitis. CONCLUSION: Earl y diagnosis and aggressive surgical debridement in patients with postp artum and vulvar necrotizing fasciitis may improve the outcome. Histop athologic findings are remarkably consistent and may help to confirm t he diagnosis.