Prognostic factors Influencing Necrotizing Soft tissue lesions in North India

Abstract

Background: Severe skin or soft tissue (SST) infections can involve fascia planes, thereby constitution necrotizing fascitis. Such infections are characterized by extensive necrosis and systemic toxicity [1,2] . Early clinical diagnosis of necrotizing fascitis and superficial SST infection (erysipelas or cellulitis), may be difficult [3,4] . Method: At the time of admission a detailed clinical history were taken, clinical examination was done, patients were admitted and stabilized in emergency ward, aggressive debridement of infected and necrotizing tissue. All necrotic skin, subcutaneous tissue, fascia and nonviable muscle were removed, the excised tissue was sent for culture and sensitivity in microbiology laboratory. All the viable skin and soft tissues were saved to aid later closure. Result: the survival rate was 86.5% in patients who underwent surgical debridement in early stage of disease as compared to 61.5% mortality in patients who presented late. Septicemic shock and multiple organ failure was less in patients who presented at early stage of disease. Early and adequate nutritional support along with prompt recognition and treatment reduces the development of multiple organ failure and improves the outcome. Conclusion:Mortality rate is decreased in those patients who are treated in early cause of disease by means of surgical and medical approach. The mortality rate is directly proportional to involved body surface area in patients of Necrotizing soft tissue lesion. Site of lesion and extent of lesion influences the mortality.