Abstract
Necrotising fasciitis (NF) of the extremities is a rapidly progressive, potentially life threatening soft tissue infection. Recent advances in its management, like hidrobisturi-assisted debridement (Versajet®), negative pressure wound therapy (NPWT), or Intravenous Immunoglobulin (IVIG) have not clearly influenced in mortality and morbidity rates, still high. We therefore sought to study the necrotising fasciitis of the extremities diagnosed in the last four year in our hospital. We investigate (1) the morbidity and mortality rates, (2) the microbiologic characteristics of the infection, and (4) the management focusing on the use of new treatment technologies.
This is a 4-year retrospective chart review of all NF of the extremities who presented in our hospital, from 2010 through 2013. We collected data on demographics, comorbidities, diagnostic test, LRINEC score and microbiological information. We evaluated the therapeutic management of these patients, focusing in the intensive care necessities, the use of hidrobisturi and NPWT as well the treatment with IVIG
20 patients satisfied our inclusion criteria. Lower extremity was the most common location of infection (60%). Blood cultures were available in 14 cases, 7 with a negative culture result (50%). The average LRINEC score on the day of presentation was 6 (range: 0–11). All the patients were treated operatively with 2.5 interventions on average (range: 1 to 5 operations). In the operative samples, one or more causative microorganisms were identified in 18/20 (90%) of the NF cases, with two culture negative cases. Overall, type II NF (Group A β-haemolytic streptococci) was found in 11 cases (55%) and Type I (synergistic polymicrobial) in 7 cases (35%). Versajet® was used in the first debridement in 40% (8 out 20) of the cases and in the second-look in 80% of the cases. In 5 cases (25%) a direct wound closure was selected and in 75% cases a VAC closure was the technique of choice. Thirteen patients (65%) were admitted in the intensive care unit, with a medium stay of 12 days. The overall mortality was 30 % with LRINEC score, glucose level and creatinin level being an independent risk factor of death (p < .05). Five amputations were identified in this series (25%).
According our data, despite surgical advances, pharmacological new drugs and intensive care improvements, NF remains a disease with high mortality and morbidity. New technologies have been used widely in the last four years in our center without appearing to influence the final outcome of the disease.
