Necrotising fasciitis: an entity revisited.
Necrotising fasciitis is a disease that still carries a high morbidity and mortality despite our better understanding and advances in treatment since 1924 when Meleney first studied it. In our Department of Orthopaedics, this condition appears to be on the increase, and we therefore felt this entity deserved a restudy. Since 1985, 15 cases were seen, of which 10 were encountered in 1989. There were no recorded case prior to 1985. Our initial results show that the background and outcome parallel that of previous authors. Most were elderly with some form of underlying chronic disease. The duration from symptom onset to presentation was short, with many being in a state of septicaemia at the time of admission with fever, metabolic acidosis and marked leucocytosis. Repeated desloughings were common, and four ended up with some form of limb amputation. As with Meleney's study, the consistent pathogen cultured was B-haemolytic streptococcus. Our recommendation is that we should be more aware of this entity in view of its fulminant course, with early and aggressive surgical intervention being the keystone to management.
Dept of Orthopaedic Surgery, Toa Payoh Hospital, Singapore.
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D005208:Fasciitis / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology; D013290:Streptococcal Infections / Q000453:epidemiology / Q000382:microbiology; D013292:Streptococcus agalactiae / Q000302:isolation & purification