A review of necrotising fasciitis in the extremities.
OBJECTIVE
To review currently available evidence on the epidemiology and methods of management for necrotising fasciitis, with particular reference to Hong Kong.


METHODS
Medline, PubMed, and Cochrane Library searches of local and internationally published English language journals, from 1990 to July 2008 using the terms 'necrotising fasciitis', 'Hong Kong', 'diagnosis', 'epidemiology', 'vibrio', 'streptococci', 'clostridia', and 'management'.


METHODS
All articles involving necrotising fasciitis in Hong Kong were included in the review.


RESULTS
The incidence of necrotising fasciitis in Hong Kong and around the world has been increasing. This rapidly progressive infection is a major cause of concern, due to its high morbidity and mortality. Up to 93% of affected patients at our hospital were admitted to the Intensive Care Unit and many still died from septic complications, such as pneumonia and multi-organ failure. Radical debridements in the form of amputations and disarticulations were considered vital in 46% of the patients. Early recognition and treatment remain the most important factors influencing survival. Yet, early diagnosis of the condition is difficult due to its similarities with many other soft tissue disorders such as cellulitis. Repeated surgical debridement or incisional drainage continues to be essential for the survival of sufferers from necrotising fasciitis. Many authorities have reported that carrying out the first fasciotomy and radical debridement within 24 hours of symptom onset was associated with significantly improved survival, which also emphasises the importance of early diagnosis.


CONCLUSIONS
Clinicians must adopt a high index of suspicion for necrotising fasciitis. Empirical antibiotics must be started early and repeated physical examinations should be performed, while maintaining a low threshold for tissue biopsy and surgery. The timing of the first fasciotomy and radical debridement within a window of 24 hours from symptom onset is associated with significantly improved survival.
Cheung
Jason P Y
JP
Department of Orthopaedics and Traumatology, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong. jcheung98@hotmail.com
Fung
Boris
B
Tang
W M
WM
Ip
W Y
WY
D000333:Aeromonas / Q000472:pathogenicity; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003015:Clostridium Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D015897:Comorbidity; D003646:Debridement; D042241:Early Diagnosis; D019115:Fasciitis, Necrotizing / Q000150:complications / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D006092:Gram-Negative Facultatively Anaerobic Rods / Q000472:pathogenicity; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D006931:Hyperbaric Oxygenation; D012307:Risk Factors; D013290:Streptococcal Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D013297:Streptococcus pyogenes; D014735:Vibrio Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy
D000900:Anti-Bacterial Agents