Necrotizing fasciitis. Role of early surgical intervention.
OBJECTIVE
To evaluate our experience of management of necrotizing fasciitis (NF) particularly the role of early and aggressive surgical intervention.


METHODS
This is a retrospective review of the cases affected by this disease and managed at Riyadh Medical Complex, Riyadh, Kingdom of Saudi Arabia, during 5 calendar years from 1996 through to 2000 (1416-1420 A.H). The preoperative and operative data was collected, and postoperative morbidity and mortality were analyzed.


RESULTS
A total of 25 cases of NF were treated during the 5-year period, 18 were males and 7 female. The majority of patients had perianal suppuration as the primary lesion, followed by groin area in drug addicts and only 2 cases were primarily in the upper limbs. Diabetes and drug addiction were the main predisposing factors. All but 3 infections were polymicrobial, with streptococci and acinobacter being the most frequent organisms. The mainstay of treatment depends on a high index of suspicion, aggressive early and repeated debridements and adequate antibiotic coverage. The overall mortality was 24% but the drastic reduction in mortality was observed with early surgical intervention.


CONCLUSIONS
The results highlight the role of early diagnosis; prompt and aggressive surgical debridements are critical for improved survival.
Qazi
Shabir A
SA
Department of General Surgery, Riyadh Medical Complex, Kingdom of Saudi Arabia. smmirza@hotmail.com
Mohammed
Abdulmajeed A
AA
Saber
Elsanousi I
EI
Mirza
Shaukat M
SM
D000151:Acinetobacter Infections / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D003131:Combined Modality Therapy; D003646:Debridement; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D019115:Fasciitis, Necrotizing / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012529:Saudi Arabia / Q000453:epidemiology; D016038:Skin Transplantation; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery*; D013290:Streptococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery*; D016019:Survival Analysis
D000900:Anti-Bacterial Agents