Necrotising fasciitis: experience with 32 children.

BACKGROUND: Necrotising fasciitis (NF) in children is rare, rapidly progressive and potentially fatal. A satisfactory outcome depends on early diagnosis and aggressive surgical debridement, along with appropriate antibiotic therapy.

AIM: The aim was to describe the various presentations of NF and evaluate outcome of treatment.

PATIENTS AND METHODS: This was a 4-year prospective, descriptive study of all consecutive cases of NF aged 15 years and under treated at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria from January 2001 to December 2004.

RESULTS: Thirty-two children were treated during the study period. The male:female ratio was 1.7:1. Ages ranged from 6 days to 12 years (mean 2 yrs). The commonest predisposing factors were malnutrition (40.6%), boils (37.5%) and intravenous canulation (9.4%). Duration of symptoms ranged from 3 to 19 days (mean 6.4) and the total body surface areas involved ranged from 2% to 16% (mean 5.9%). Half of the patients presented with involvement of the trunk, followed by head/neck (28.1%), upper limbs (21.9%), lower limbs (6.3%) and perineum (6.3%). Most patients had polymicrobial infection, but the organism most commonly isolated was Staphylococcus aureus (71.9%). All patients were resuscitated and had surgical wound debridement, antibiotics and wound care. Final wound resurfacing was by secondary intention (46.9%), direct suturing (6.3%), split thickness skin grafting (21.9%) and local flap reconstruction (12.5%). Septicaemia was the commonest complication (71.9%). The mortality rate was 9.4%. Duration of hospital stay ranged from 14 to 96 days (mean 27.6). Follow-up ranged from 3 weeks to 6 months (mean 52.4 days).

CONCLUSION: NF in children is not uncommon in Nigeria. It is associated with significant morbidity, but mortality can be reduced remarkably by early diagnosis and aggressive treatment.