Severe necrotising soft tissue infections in orthopaedic surgery

Abstract

Purpose. To review all cases of necrotising infection managed in the Department of Orthopaedic Surgery of Dunedin Hospital in New Zealand between 1989 and 1998. Methods. Hospital records were analysed for pre-disposing factors, clinical features, diagnostic results, treatment strategies, and outcomes. Results. 13 cases (9 males and 4 females) of necrotising infection were identified. The mean age was 48 years (range, 8-76 years). Presenting symptoms included painful swelling, erythema, and necrosis. Most patients had predisposing factors and had received nonsteroidal anti-inflammatory drugs before presentation. 12 patients underwent surgical debridement including a total of 4 amputations. Septic shock developed in 9 patients who required dialysis for renal failure. Four patients died. The most common organisms identified were group A beta-haemolytic streptococci. Conclusion. Severe necrotising infections require a high index of suspicion and rapid medical and surgical intervention to reduce the mortality and morbidity.