Surgical concept and results in necrotizing fasciitis

Introduction: Necrotizing fasciitis (NF) is a rapidly progressive soft tiss ue infection involving primarily the superficial fascia and subcutaneous ti ssue. The disease is caused by Streptococcus pyogenes or synergistic infect ion of anaerobic and facultative anaerobic bacteria. Further characteristic s are severe, intolerable pain and a mortality of 30-50%. Patients and meth ods: From January 1996 to January 2000 12 patients underwent treatment for NE The patients' charts were investigated retrospectively. Results: In 7 pa tients the bacterial cultures showed a mixed, polymicrobial infection and i n 5 cases only Streptococcus pyogenes. The NF was localized at the upper ex tremity (2), abdomen (3), back (1), hip (2) and lower extremity (4). The ar ea involved was 8 (4-11)% of the total body surface. The surgical procedure s in 12 patients were debridement (60x), local transposition flap (2), free muscle flaps (3), lower leg amputation (1) and split thickness skin graft (3x). Four patients developed streptococcal toxic shock syndrome and two di ed. In total there were four deaths with a mortality of 33%. In the "surviv or group" the time to diagnosis was 2.8 (1-7) days, the time to radical sur gery 3.3 (1-9) days. In the "mortality group" it was 6.8 (3-10) days or 9.3 (6-12) days. Conclusion: The prognosis of NF seems to be influenced by the site of the infection, because 4 out of 6 patients with NF of the abdomen, back or hip died, but all patients with NF of the extremities survived. Th e age of the patient is not a key parameter, because also young and previou sly healthy people also die from the streptococcal toxic shock syndrome. Th e interval between diagnosis and radical debridement appears to be the cruc ial factor in terms of prognosis, since early diagnosis and prompt, radical surgery improves the survival rate.