Postpartum and vulvar necrotizing fasciitis. Early clinical diagnosis and histopathologic correlation.
OBJECTIVE
To review the clinical course and correlate histopathologic findings of obstetrics and gynecology patients with necrotizing fasciitis


METHODS
Seven-teen patients with postpartum or vulvar necrotizing fasciitis were identified from 1981 to 1996. Medical records were retrospectively reviewed. Information was available for all patients until death or discharge from the hospital. Histopathologic material on 15 patients was available for review.


RESULTS
Five postpartum patients were diagnosed and surgically debrided one to nine days after cesarean delivery, with no mortality. Twelve patients with vulvar necrotizing fasciitis were diagnosed and surgically debrided <1-10 days after presentation to a physician, with three deaths (25%). On histopathologic review, all cases had prominent lobular and septal panniculitis. Thirteen cases had histologic evidence of fasciitis.


CONCLUSIONS
Early diagnosis and aggressive surgical debridement in patients with postpartum and vulvar necrotizing fasciitis may improve the outcome. Histopathologic findings are remarkably consistent and may help to confirm the diagnosis.
Department of Obstetrics, Gynecology, Brigham and Women's Hospital, Boston, Massachusetts 02115. USA.
J O
JO
Schorge
S R
SR
Granter
L H
LH
Lerner
S
S
Feldman
D000328:Adult; D003646:Debridement; D003937:Diagnosis, Differential; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008428:Maternal Mortality; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000401:mortality / Q000473:pathology*; D011379:Prognosis; D014845:Vulvar Diseases / Q000382:microbiology* / Q000473:pathology / Q000601:surgery