title: [Necrotizing fasciitis: diagnosis, treatment and review of the literature].
abstract: BACKGROUND
  Necrotizing fasciitis (NF) is characterized by rapidly spreading necrosis of the soft tissue and fascia. It is rare, but can be fatal if not managed properly. The aim of this study was to discuss the morbidity and mortality in NF patients in terms of evaluating early diagnostic techniques and reconstructive options.
  
  
  METHODS
  Sixty-eight patients (59 male, 9 female; mean age 55.9 years; range 28 to 88 years) with localized NF who were treated between 2000 and 2010 were assessed retrospectively for age, sex, localization, time elapsed between onset of symptoms and diagnosis, predisposing factors, characteristics of tissue defects, isolated microbiological agents, surgical intervention, complications, and mortality rate.
  
  
  RESULTS
  In 52 patients (76.4%), comorbidities such as diabetes, obesity, smoking, and corticosteroid use were present. The most common localization was the perineum and inguinal region (n=48, 70.5%). Time elapsed between onset of symptoms and diagnosis was 6.2 days (1-12 days). The mean size of tissue defect after the first debridement procedure was 54.2 cm2 (28-82 cm2). The most common isolated microbiological agents were as follows: Escherichia coli, Enterococci, and Pseudomonas aeruginosa. Polymicrobial infections were encountered in 54 patients (79.4%). The most common reconstructive procedures were fasciocutaneous flap + split-thickness skin grafting (n=39, 57.3%). No major complication was observed; minor complications included wound dehiscence and partial graft loss. The mortality rate was 13.2% (n=9).
  
  
  CONCLUSIONS
  The early diagnosis of NF may be lifesaving. When NF is suspected, early debridement of necrotic tissues should be performed. As soon as the infection and the spread of the necrosis are controlled, reconstruction should be considered.
authors.affiliation: Department of Plastic Reconstructive and Aesthetic Surgery, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey. haluk.vayvada@deu.edu.tr
authors.forename: Haluk
authors.initials: H
authors.lastname: Vayvada
authors.forename: Cenk
authors.initials: C
authors.lastname: Demirdöver
authors.forename: Adnan
authors.initials: A
authors.lastname: Menderes
authors.forename: Can
authors.initials: C
authors.lastname: Karaca
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D003646:Debridement; D048909:Diabetes Complications / Q000453:epidemiology; D019115:Fasciitis, Necrotizing / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006119:Groin; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D010502:Perineum; D012189:Retrospective Studies; D012307:Risk Factors; D016038:Skin Transplantation; D012907:Smoking / Q000453:epidemiology; D013524:Surgical Flaps
chemical_list: D000305:Adrenal Cortex Hormones