Necrotizing Fasciitis of the Upper Limb: Optimizing Management to Reduce Complications

Abstract

Background: Necrotizing fasciitis (NF) is a severe, potentially life-threatening condition. The aim of this study is to identify strategies aimed at reducing complications in patients with NF of the upper limb. Methods: We conducted a retrospective study on patients admitted to our Unit for suspected NF of the upper limb. The analyzed data included patient characteristics, delay before primary care, clinical and biological signs upon arrival, pathogens involved, and the rate of amputations and mortality. Results: A total of 21 patients presented with confirmed necrotizing bacterial dermohypodermitis-NBDH with NF (NBDH-NF) affecting the upper limb. The mean delay between the onset of symptoms and the clinical examination in the Emergency Dermatology Unit was 48 h (range: 6 to 72 h). The mean delay between admission and primary surgery was 150 min (range: 60 min to 280 min). No amputations were performed. All patients were alive one year after the first surgical procedure. Conclusions: Our study demonstrated that it is possible to reduce mortality and morbidity rates in NF of the upper limb. Timely diagnosis and early treatment and a multidisciplinary medico-surgical dedicated team providing care can significantly modify the outcomes. Early surgical debridement is the most important factor affecting the prognosis of these infections.

Practical Review of Necrotizing Fasciitis: Principles and Evidence-based Management

“…78 The use of STSGs and full-thickness skin grafting for extremity wound reconstruction was also described by La Padula et al In their case series, only one flap (dorsal metacarpal artery flap) was performed in a secondary procedure for interphalangeal joint resurfacing. 79 Positive outcomes of skin grafting and NPWT for lower extremity NF have also been reported. [80][81][82] Flaps with/without skin grafting may be used for complex and extensive defects.…”

“…83 These procedures are relatively common, as up to one-quarter of NF patients still undergo amputation. 78,79,84 Perineum Defects (Fournier Defects)…”