Clinical study of necrotizing fasciitis and its management

Abstract

Background: Necrotizing fasciitis is a severe flesh-eating disease of soft tissue infection. It is characterized by widespread infection of the fascia with necrosis. It may lead to MODS and shock in a very short period of time. In this study we have evaluated the predisposing factors, clinical manifestation and different modalities of investigation which helps in management of this near fatal disease.Methods: This study was conducted in Department of Surgery, Gandhi Medical College, Bhopal, Madhya Pradesh, India for 3 years (October 2013-September 2016). A total of 107 patients having necrotising fasciitis were admitted in this period. The diagnosis was confirmed by detailed history and physical examination followed by haematological, microbiological and radiological investigations priority wise. After initial resuscitation patients were taken to OT where debridement of dead necrotic tissue was done, laying open of deeper planes with proper and effective drainage of pus. Most of the dressings used were silver sulfadiazine or iodine depending upon the sensitivity to sulpha group.Results: Diabetes mellitus was the most common predisposing factor (65.4%) followed by trauma (28%). Perineum and thigh were the most commonly affected site (70%). Most of the patients (84%) presented with skin erythema and blistering. Fever and tachycardia were seen in almost all the patients (95%). Leukocytosis and neutrophilia were seen in 91.5%. Most common organisms isolated were E. coli and proteus. Mortality rate was 24.29%.Conclusions: Necrotizing fasciitis is a flesh eating, highly lethal disease. Early diagnosis, early and radical surgical debridement supported by appropriate antibiotic and correction of metabolic disorder are the cornerstones of successful management.