Necrotizing fasciitis: management and outcome.

OBJECTIVE: To observe the various clinical presentations of necrotizing fasciitis and evaluate their management and outcome.

DESIGN: An observational descriptive study.

PLACE AND DURATION OF STUDY: Surgical-c unit of Khyber Teaching Hospital, Peshawar, from July 2001 to June 2002.

SUBJECTS AND METHODS: The study included 20 patients of necrotizing fasciitis treated during this period. Age, gender, clinical presentation and predisposing factors were recorded. Pus was cultured and the isolated organism and their sensitivity identified. Management included broad-spectrum antibiotics, extensive and frequent debridements along with supportive measures.

RESULTS: Common age group was 21-40 years with a male predominance. eight patients had necrotizing fasciitis of inguinoscrotal and perineal region, while 6 each had abdomen and 6 with necrotizing fasciitis of the limbs involvement. Factors predisposing to infection were diabetes in 5 patients, abscess in 6, trauma in 3 and surgery in 3 patients, while no specific cause was found in 3 cases. Escherichia (E. coli), Bacteroids, Enterococci and Streptococci were the commonest organisms isolated. All were sensitive to a combination of piperacillin and ampicillin. Debridements were done 1-5 times in most cases. Fifteen patients (75%) had complete recovery, 2 (10%) went to other hospitals on their own, 2 (10%) patients expired while one patient was referred to the plastic surgery unit.

CONCLUSION: Necrotizing fasciitis has multiple etiology and predisposing factors. The bacteriology is poly microbial. Early presentation and diagnosis, supportive measures, broad-spectrum antibiotics, prompt and aggressive surgical debridements remains the cornerstone of management.