title: Necrotizing fasciitis: management and outcome.
abstract: OBJECTIVE
  To observe the various clinical presentations of necrotizing fasciitis and evaluate their management and outcome.
  
  
  METHODS
  An observational descriptive study.
  
  
  METHODS
  Surgical-c unit of Khyber Teaching Hospital, Peshawar, from July 2001 to June 2002.
  
  
  METHODS
  The study included 20 patients of necrotizing fasciitis treated during this period. Age, gender, clinical presentation and predisposing factors were recorded. Pus was cultured and the isolated organism and their sensitivity identified. Management included broad-spectrum antibiotics, extensive and frequent debridements along with supportive measures.
  
  
  RESULTS
  Common age group was 21-40 years with a male predominance. eight patients had necrotizing fasciitis of inguinoscrotal and perineal region, while 6 each had abdomen and 6 with necrotizing fasciitis of the limbs involvement. Factors predisposing to infection were diabetes in 5 patients, abscess in 6, trauma in 3 and surgery in 3 patients, while no specific cause was found in 3 cases. Escherichia (E. coli), Bacteroids, Enterococci and Streptococci were the commonest organisms isolated. All were sensitive to a combination of piperacillin and ampicillin. Debridements were done 1-5 times in most cases. Fifteen patients (75%) had complete recovery, 2 (10%) went to other hospitals on their own, 2 (10%) patients expired while one patient was referred to the plastic surgery unit.
  
  
  CONCLUSIONS
  Necrotizing fasciitis has multiple etiology and predisposing factors. The bacteriology is poly microbial. Early presentation and diagnosis, supportive measures, broad-spectrum antibiotics, prompt and aggressive surgical debridements remains the cornerstone of management.
authors.affiliation: Department of General Surgery, Khyber Teaching Hospital, Peshawar. roohul@yahoo.com
authors.forename: Roohul
authors.initials: R
authors.lastname: Muqim
mesh_terms: D000328:Adult; D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003646:Debridement; D019115:Fasciitis, Necrotizing / Q000382:microbiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D010878:Piperacillin / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000667:Ampicillin; D010878:Piperacillin