Necrotizing fasciitis: a surgical emergency

Abstract

Accurate assessment and timely interventions are critical in the treatment of patients affected with necrotizing fasciitis, a rare, fulminating, potentially life-threatening, infectious process of the soft tissues. Understanding the natural history and unique characteristics of this disease is crucial to achieve early recognition, effective management and a favorable patient outcome. Classic symptoms include severe pain, erythema, mottling, crepitus, skin anesthesia, warmth, tenderness, bullous formations and edema in the affected area and fever. This article aims at reviewing the information known about this disease, collected from various sources. Radical surgical debridement, broad-spectrum antibiotics, negative pressure wound therapy and hyperbaric oxygen therapy are considered to be the cornerstones of treatment.

Necrotising Fasciitis: A Clinicopathological Study

“…[2][3][4][5]7] Surgery Emergency surgical debridement of the affected tissues is the primary management modality for NF. Surgical debridement, necrosectomy, and fasciotomy are the main aspects of surgical treatment.…”

“…[23] The mortality rates for NF vary considerably with the best centres claiming less than 10% and others as high as 75%. [2][3][4][5]7] The larger, more comprehensive retrospective studies have narrowed these rates between 25% and 40%. The outcome is also region-specific with truncal (44%) and perineal (28%) having higher mortality than extremities (22%), presumably due to the option of amputation of the limb in the event of an extensive infection.…”

Necrotizing fasciitis: The importance of early diagnosis, prompt surgical debridement and adjuvant therapy

“…Population-based surveillance for group A streptococcal necrotic infection in Canada showed an incidence range from 0.15 to 0.55 cases per 100,000 in those younger than 45 to those older than 65 years [11]. Increasing age is a consistent risk factor across several case series, although the conditions can affect any age group [1][2][3][4][5]. An accurate predictor of the disease has not been consistently demonstrated.…”

“…The condition is difficult to diagnose early and even more difficult to manage effectively [1][2][3]. Early clinical suspicion, appropriate antimicrobials and surgery are key to improving survival.…”

“…Early clinical suspicion, appropriate antimicrobials and surgery are key to improving survival. Mortality rate has been reported to vary from 4.2% to 75% [1][2][3][4][5]. The significant difference is closely linked to early recognition and expeditious initial excision and debridement of the infected tissues along with appropriate antimicrobials.…”