Factors affecting the mortality of necrotizing fasciitis involving the upper extremities.
OBJECTIVE
Necrotizing fasciitis involving the upper extremities is an uncommon, but potentially life-threatening infection. Surgical records were reviewed to identify its mortality risk factors.


METHODS
A 10-year retrospective review was conducted of all patients with upper limb necrotizing fasciitis treated in a tertiary care hospital in northern Taiwan. The demographic data, physical and laboratory findings and salient information with respect to the treatment and clinical outcome were collected and analyzed.


RESULTS
Fourteen patients were identified. The mean age of the all-male cohort was 60.2 years (range, 44-83 years). Five of the patients died, yielding a mortality rate of 35.7%. At the time of presentation, all 14 patients had pain and swelling, but fever occurred in only 7 patients. Associated chronic debilitating diseases, of which diabetes mellitus was the most common, were present in 9 individuals. Patients underwent an average of two surgical debridements. The initial presentation in a state of altered consciousness or respiratory distress was found to be a statistically significant factors for eventual mortality (P < 0.05).


CONCLUSIONS
The results showed that necrotizing fasciitis of the upper extremity is associated with a high mortality rate. Early diagnosis and referral for aggressive surgical treatment before the development of systemic toxic signs are therefore considered to be essential for survival.
Cheng
Nai-Chen
NC
Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, 7 Chung-Shan South Road, Taipei, 100, Taiwan.
Su
Yu-Min
YM
Kuo
Yuan-Sung
YS
Tai
Hao-Chih
HC
Tang
Yueh-Bih
YB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003646:Debridement; D003920:Diabetes Mellitus / Q000453:epidemiology; D019115:Fasciitis, Necrotizing / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016038:Skin Transplantation; D013624:Taiwan / Q000453:epidemiology; D034941:Upper Extremity