Necrotizing fasciitis: improved survival with early recognition by tissue biopsy and aggressive surgical treatment.
BACKGROUND
Necrotizing fasciitis is a soft tissue gangrenous infection that is optimally treated by early diagnosis, radical surgical debridement of all involved necrotic tissue, broad spectrum antibiotics, and aggressive nutritional support. The early clinical diagnosis of an area of necrotizing fasciitis is difficult and frequently unreliable. We are reporting a series of cases in which an early, accurate diagnosis of necrotizing fasciitis was established by a frozen section tissue biopsy obtained at the bedside.


METHODS
Over a 15-year period, a consecutive series of 43 patients had a bedside biopsy under local anesthesia with immediate frozen section evaluation. All patients were seen in the hospital or emergency room for treatment of an inflammatory process.


RESULTS
These 43 patients had bedside biopsy and frozen section evaluation of an inflammatory process. Twelve patients were found to have necrotizing fasciitis. These patients were treated with immediate surgical debridement of all gross necrotic tissue, broad spectrum antibiotics, and adequate nutritional support. All of them survived. No cases of infectious gangrene occurred in the group of patients whose biopsy did not reveal necrotizing fasciitis.


CONCLUSIONS
Frozen section tissue biopsy is a useful adjunct in establishing an early, accurate diagnosis of infectious gangrene.
Majeski
J
J
Majeski
E
E
D000038:Abscess / Q000175:diagnosis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001706:Biopsy; D002481:Cellulitis / Q000175:diagnosis; D003131:Combined Modality Therapy; D003646:Debridement; D003937:Diagnosis, Differential; D004927:Escherichia coli Infections / Q000473:pathology / Q000601:surgery / Q000628:therapy; D019115:Fasciitis, Necrotizing / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D005260:Female; D005629:Frozen Sections; D005734:Gangrene / Q000473:pathology / Q000601:surgery / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D018529:Nutritional Support; D010362:Patients' Rooms; D011512:Proteus Infections / Q000473:pathology / Q000601:surgery / Q000628:therapy; D015203:Reproducibility of Results; D013203:Staphylococcal Infections / Q000473:pathology / Q000601:surgery / Q000628:therapy; D015996:Survival Rate; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents