M. Rangaswamy, Necrotizing fasciitis: a 10-year retrospective study of cases in a single university hospital in Oman, ACT TROP, 80(2), 2001, pp. 169-175
Objective: (1) To study the clinical profile of all cases of necrotizing fa
sciitis (NF) diagnosed in a university hospital in Oman. (2) To evolve a st
rategy for early diagnosis. Patients and Methods: The inpatient records of
the Sultan Qaboos University hospital from 1990-99 were searched for the wo
rds 'fasciitis', 'necrosis' or 'gangrene' and cases of NF (defined as a sof
t tissue infection characterized by widespread necrosis of the subcutaneous
tissues cofirmed at surgery or pathology or both) were selected and analyz
ed. Cases with necrosis due to other obvious causes were excluded, Results:
Of the seven cases of NF (hospital incidence-8.4/10(5)), there were three
post-operative, three spontaneous and one post-traumatic. Sites involved: u
pper limb (1), lower limb (2), abdomen (2), gluteal (1), and breasts (1). T
he median age was 50 years (range 21-85) and the male:female ratio was 4:3.
All patients had local pain out of proportion to the signs and six had fev
er. Hypotension, liver or kidney dysfunction or coagulopathy were seen in f
our and a drop in haemoglobin was seen in six. In none was NF even consider
ed by the referring or admitting physician, diagnosis being delayed by 2-10
days. In four cases a diagnostic incision under local anesthesia revealed
the correct diagnosis. At surgery, extensive fascial and fat necrosis were
seen in all, but only two had myonecrosis. The commonest isolate was P-hemo
lytic group D streptococcus (4/7). Blood and tissue were positive for P-hem
olytic group A streptococci in one fatal case, Mean hospital stay was 54.5
days (11-134), mean surgical procedures were 2.3 per case, two required ICU
admission with one death. Conclusion: NF is a rare but serious bacterial d
isease that is often incorrectly diagnosed. Unexplained severe local pain,
deep tenderness without impressive local signs, fall in haemoglobin, organ
system dysfunction and constitutional upsets were regular features. A high
index of suspicion and immediate direct inspection of the fascia facilitate
s an early diagnosis. (C) 2001 Elsevier Science B.V. All rights reserved.