Early recognition and treatment modality in necrotizing fasciitis

Necrotizing fasciitis is an uncommon but life-threatening soft tissue infection characterized by rapidly spreading inflammation and necrosis of the skin, subcutaneous fat and fascia. Early recognition is difficult due to the minimal changes of cutaneous findings in the early course of the disease. Radiographic studies, finger test, frozen section biopsy examinations and laboratory studies are useful for early diagnosis of necrotizing fasciitis. High clinical index of suspicion help to early treatment. The delay between hospital admission and initial debridement is the most critical factor influencing morbidity and mortality.The purpose of this study is to emphazise early detection of necrotizing fasciitis and to demonstrate importance of early and repetetive surgical debridement if necessary by sharing our clinical experience in this matter. Seventeen patients (13 women, 4 men) who underwent treatment by necrotizing fasciitis diagnosis between September 2005 to December 2007 were studied. Patients chart reviewed retrospectively by their age, sex, etiology, predispozan factors, laboratory findings, clinical findings, application period, site of infection, culture results, treatment modality and results.The mean age of patients were 59 ( between 34-77). The most common etiologic factor was surgery with 6 patients (%35.2), the most common predispozan factors were diabetes and obesity by 6 patients (%35.2). E. coli was the most common isolated bacteria (in 4 patients, %23.5). 15 patients have undergone more than one debridement. The mean number of debridement were 3.7. The skin defects come out after debridement were closed with skin graft or closed primarily.This study showed the importance of high clinical suspicion, early diagnosis, effective medical and surgical treatment for low morbidity and mortality in necrotizing fasciitis