Factors affecting the mortality of necrotizing fasciitis involving the upper extremities.

PURPOSE: Necrotizing fasciitis involving the upper extremities is an uncommon, but potentially life-threatening infection. Surgical records were reviewed to identify its mortality risk factors.

METHODS: A 10-year retrospective review was conducted of all patients with upper limb necrotizing fasciitis treated in a tertiary care hospital in northern Taiwan. The demographic data, physical and laboratory findings and salient information with respect to the treatment and clinical outcome were collected and analyzed.

RESULTS: Fourteen patients were identified. The mean age of the all-male cohort was 60.2 years (range, 44-83 years). Five of the patients died, yielding a mortality rate of 35.7%. At the time of presentation, all 14 patients had pain and swelling, but fever occurred in only 7 patients. Associated chronic debilitating diseases, of which diabetes mellitus was the most common, were present in 9 individuals. Patients underwent an average of two surgical debridements. The initial presentation in a state of altered consciousness or respiratory distress was found to be a statistically significant factors for eventual mortality (P < 0.05).

CONCLUSION: The results showed that necrotizing fasciitis of the upper extremity is associated with a high mortality rate. Early diagnosis and referral for aggressive surgical treatment before the development of systemic toxic signs are therefore considered to be essential for survival.