title: Necrotizing fasciitis of the lower limb: an outcome study of surgical treatment.
abstract: Necrotizing fasciitis is a limb- and life-threatening rapidly spreading infection affecting the deep fascia with secondary necrosis of the subcutaneous tissue. It requires immediate medical attention and emergency surgery to prevent morbidity and death. This study was undertaken to determine its co-morbidity and risk factors affecting the outcome of its surgical treatment. This is a retrospective review of 36 cases of necrotizing fasciitis of the lower limb treated in our center between 1998 and 2002. Only 19% of the cases were correctly diagnosed upon admission and 48.6% were initially diagnosed as 'cellulitis'. Diabetes mellitus was the most common co-morbid. Pseudomonas, Staphylococcus, Streptococcus and Enterobactericae were the common pathogens isolated. Ten patients (27.8%) had major amputation as part of radical debridement. The overall mortality rate was 36% with laboratory parameters: high serum urea and creatinine, and low haemoglobin levels were predictors for higher mortality. Poor white cell response which is common in diabetic patients and a delay in surgical debridement were. notable attributes to a higher mortality. Necrotizing fasciitis is a serious infection associated with significant morbidity and mortality. A poor white blood cell response, high serum urea and creatinine, and low haemoglobin level were the predictors for mortality. Early diagnosis and prompt treatment are of paramount importance in the treatment of this infection.
authors.affiliation: Department of Orthopaedic Surgery, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: M K
authors.initials: MK
authors.lastname: Kwan
authors.forename: A
authors.initials: A
authors.lastname: Saw
authors.forename: E K
authors.initials: EK
authors.lastname: Chee
authors.forename: C S
authors.initials: CS
authors.lastname: Lee
authors.forename: C H
authors.initials: CH
authors.lastname: Lim
authors.forename: N A
authors.initials: NA
authors.lastname: Zulkifle
authors.forename: N H
authors.initials: NH
authors.lastname: Saarey
authors.forename: M N
authors.initials: MN
authors.lastname: Mohamad Hussien
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003646:Debridement; D019115:Fasciitis, Necrotizing / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007866:Leg / Q000382:microbiology* / Q000601:surgery*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors