[Surgical concepts and results in necrotizing fasciitis].
BACKGROUND
Necrotizing fasciitis (NF) is a rapidly progressive soft tissue infection involving primarily the superficial fascia and subcutaneous tissue. The disease is caused by Streptococcus pyogenes or synergistic infection of anaerobic and facultative anaerobic bacteria. Further characteristics are severe, intolerable pain and a mortality of 30-50%.


METHODS
From January 1996 to January 2000 12 patients underwent treatment for NF. The patients' charts were investigated retrospectively.


RESULTS
In 7 patients the bacterial cultures showed a mixed, polymicrobial infection and in 5 cases only Streptococcus pyogenes. The NF was localized at the upper extremity (2), abdomen (3), back (1), hip (2) and lower extremity (4). The area involved was 8 (4-11)% of the total body surface. The surgical procedures in 12 patients were debridement (60x), local transposition flap (2), free muscle flaps (3), lower leg amputation (1) and split thickness skin graft (3x). Four patients developed streptococcal toxic shock syndrome and two died. In total there were four deaths with a mortality of 33%. In the "survivor group" the time to diagnosis was 2.8 (1-7) days, the time to radical surgery 3.3 (1-9) days. In the "mortality group" it was 6.8 (3-10) days or 9.3 (6-12) days.


CONCLUSIONS
The prognosis of NF seems to be influenced by the site of the infection, because 4 out of 6 patients with NF of the abdomen, back or hip died, but all patients with NF of the extremities survived. The age of the patient is not a key parameter, because also young and previously healthy people also die from the streptococcal toxic shock syndrome. The interval between diagnosis and radical debridement appears to be the crucial factor in terms of prognosis, since early diagnosis and prompt, radical surgery improves the survival rate.
Abteilung für Verbrennungen, Plastische- und Handchirurgie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Plastische und Handchirurgie der Universität Heidelberg, Ludwigshafen. Christoph.Heitmann@urz.uni-heidelberg.de
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Heitmann
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Pelzer
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Bickert
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Menke
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Germann
D000328:Adult; D000368:Aged; D003646:Debridement; D003937:Diagnosis, Differential; D019115:Fasciitis, Necrotizing / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012772:Shock, Septic / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D016038:Skin Transplantation; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome