Necrotizing Soft-Tissue Infections in the Feet of Patients With Diabetes: Outcome of Surgical Treatment and Factors Associated With Limb Loss and Mortality

Abstract

The aim of this study was to analyze the outcomes of treatment of necrotizing soft-tissue infections (NSTIs) in the feet of diabetic patients and to determine factors associated with limb salvage and mortality. A retrospective study of a consecutive series of 145 diabetic patients suffering from NSTIs treated in the Diabetic Foot Unit, La Paloma Hospital was done. NSTIs were classified as necrotizing cellulitis if it involved the subcutaneous tissue and the skin, as necrotizing fasciitis if it involved the deep fascia, and as myonecrosis in those cases where muscular necrosis was present. In the necrotizing cellulitis group (n = 109), 8 (7.3%) major amputations were performed. In the necrotizing fasciitis group (n = 25), 13 (52%) major amputations were undertaken. In the myonecrosis group (n = 11), 6 (54.5%) major amputations were performed. Predictive variables related to limb loss were fasciitis (OR = 20, 95% CI = 3.2-122.1) and myonecrosis (OR = 53.2, 95% CI = 5.1-552.4). Predictive variables of mortality were age >75 years (OR = 10.3, 95% CI = 1.9-53.6) and creatinine values >132.6 micromol/L (OR = 5.8, 95% CI = 1.1-30.2). NSTIs of the foot are an important cause of morbidity and mortality in diabetic patients.When fascia and/or muscle are involved, there are significant risks of major amputation.

Analysis of cellulitis in diabetic lower limb along with its local complications using Amit Jain’s staging system: a cross sectional descriptive study

“…In the myonecrosis group (n = 11), 6 (54.5%) major amputations were performed. 18 Amputation is done in 25-50% of the cases in a study by Anaya et al 19 In our study, the rate of major amputation among patients with necrotizing fasciitis and myonecrosis (stage 3 and 4) was 60% and is comparable with the above results.…”

Antibiotics Versus Conservative Surgery for Treating Diabetic Foot Osteomyelitis: A Randomized Comparative Trial

“…Exclusion criteria were as follows: patients with severe infections according to Infectious Diseases Society of America classification (18); necrotizing soft tissue infections accompanying osteomyelitis (19); peripheral arterial disease; Charcot foot; glycated hemoglobin .10% (86 mmol/mol); bone exposed at the bottom of the ulcer; pregnancy; antibiotic allergies; creatinine values .98 mmol/L in women and .106 mmol/L in men; hepatic insufficiency; and patients who did not understand the purpose of the study or refused to be included.…”

Diabetic Muscle Infarction in a 59 Year Old Male: A Case Report

“…Upper extremity involvement has also been reported. 5 Clinical features usually consist of local swelling, limitation and pain on motion, tenderness, and a palpable painful mass, usually without fever and severe induration. Muscle enzymes are usually elevated and an elevated ESR was seen in about 50%.…”