title: Mortality in necrotizing fasciitis.
abstract: OBJECTIVE
  The objective of this study was to determine the mortality rate in patients presenting with Necrotizing Fasciitis. This prospective study was conducted at ward 26, JPMC Karachi over a period of two years from March 2001 to Feb 2003.
  
  
  METHODS
  All patients above the age of 12 years diagnosed to be having Necrotizing Fasciitis and admitted through the Accident and emergency department were included in this study. After resuscitation, the patients underwent the emergency exploration and aggressive surgical debridement. Post-operatively, the patients were managed in isolated section of the ward. The patients requiring grafting were referred to plastic surgery unit. The patients were followed up in outpatients department for about two years.
  
  
  RESULTS
  Over all, 25 male and 5 female patients fulfilled the inclusion criteria and were included in this study. The common clinical manifestations include redness, swelling, discharging abscess, pain, fever, skin necrosis and foul smelling discharge etc. The most common predisposing factor was Diabetes mellitus whereas the most commonly involved site was perineum. All patients underwent aggressive and extensive surgical debridements. The common additional procedures included Skin grafting, Secondary suturing, Cystostomy and Orchidectomy. Bacteroides and E. coli were the main micro-organisms isolated in this study. Bacteroides was the most common microorganism isolated among the eight patients who died.
  
  
  CONCLUSIONS
  Necrotizing Fasciitis is a potentially life threatening emergency condition and carries the mortality rate of about 26.6%. The major contributing factors to increase the mortality missed initially diagnosed, old age, diabetes mellitus truncal involvement and late presentation. Anorectal involvement of disease carry worse prognosis. Hyperbaric oxygen therapy and proper use of unprocessed honey reduced the mortality rate.
authors.affiliation: Department of Surgery, Isra University, Hyderabad. akramrajput2006@yahoo.com
authors.forename: Akram
authors.initials: A
authors.lastname: Rajput
authors.lastname: Waseem
authors.forename: Abdul
authors.initials: A
authors.lastname: Samad
authors.forename: Tariq Wahab
authors.initials: TW
authors.lastname: Khanzada
authors.forename: Gul Muhammad
authors.initials: GM
authors.lastname: Shaikh
authors.forename: Ghulam Asghar
authors.initials: GA
authors.lastname: Channa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D053715:Cystotomy; D003646:Debridement; D019115:Fasciitis, Necrotizing / Q000382:microbiology / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009919:Orchiectomy; D010154:Pakistan / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D016038:Skin Transplantation; D013536:Suture Techniques