title: Skin-Sparing Débridement for Necrotizing Fasciitis in Children.
abstract: BACKGROUND
  Necrotizing fasciitis is a serious soft-tissue infection associated with sepsis and tissue destruction. Surgical management usually requires extensive débridement of necrotic fascia and overlying skin, with significant aesthetic and functional consequences. The authors review the outcome of all recent cases of necrotizing fasciitis treated with skin-sparing débridement at their institution.
  
  
  METHODS
  The authors conducted a retrospective review of all of their cases of necrotizing fasciitis treated with skin-sparing débridement. Medical records were evaluated with a standard form gathering relevant demographic and clinical data. All cases were confirmed as necrotizing fasciitis histologically.
  
  
  RESULTS
  Ten patients were admitted with a diagnosis of necrotizing fasciitis. The median age of the patients was 4.9 years (range, 1.7 to 15.1 years). The majority of initial lesions were caused by chickenpox, mostly on the trunk. Interval from admission to surgery was 6 hours (range, 1 to 27.5 hours), with a median hospital stay of 11 days (range, 5 to 43 days). Median fasciectomy was 2.5 percent (range, 1 to 15 percent) of total body surface area, with a median skin excision of 0.25 percent of total body surface area (range, 0.1 to 3 percent). All patients received intravenous amoxicillin/clavulanic acid plus clindamycin. Delayed direct closure was possible for all patients. Median follow-up was 17 months (range, 3 to 79 months). There was no death in this series.
  
  
  CONCLUSIONS
  This surgical management restricts skin excision to the area of definite skin necrosis, limiting skin excision to one-tenth of excised fascia, with long-term favorable cosmetic and functional results.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Geneva, Switzerland.|From the Divisions of Pediatrics and Pediatric Surgery, University Center of Pediatric Surgery of Western Switzerland, University of Geneva Children's Hospital.
authors.forename: Magali S
authors.initials: MS
authors.lastname: Rüfenacht
authors.affiliation: Geneva, Switzerland.|From the Divisions of Pediatrics and Pediatric Surgery, University Center of Pediatric Surgery of Western Switzerland, University of Geneva Children's Hospital.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Montaruli
authors.affiliation: Geneva, Switzerland.|From the Divisions of Pediatrics and Pediatric Surgery, University Center of Pediatric Surgery of Western Switzerland, University of Geneva Children's Hospital.
authors.forename: Eléonore
authors.initials: E
authors.lastname: Chappuis
authors.affiliation: Geneva, Switzerland.|From the Divisions of Pediatrics and Pediatric Surgery, University Center of Pediatric Surgery of Western Switzerland, University of Geneva Children's Hospital.
authors.forename: Klara M
authors.initials: KM
authors.lastname: Posfay-Barbe
authors.affiliation: Geneva, Switzerland.|From the Divisions of Pediatrics and Pediatric Surgery, University Center of Pediatric Surgery of Western Switzerland, University of Geneva Children's Hospital.
authors.forename: Giorgio C
authors.initials: GC
authors.lastname: La Scala
mesh_terms: D000293:Adolescent; D002644:Chickenpox / Q000150:complications; D002648:Child; D002675:Child, Preschool; D003646:Debridement / Q000379:methods*; D062109:Dermatologic Surgical Procedures / Q000379:methods*; D004954:Esthetics; D019115:Fasciitis, Necrotizing / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies