title: Triple diagnostics for early detection of ambivalent necrotizing fasciitis.
abstract: Necrotizing fasciitis is an uncommon, rapidly progressive and potential lethal condition. Over the last decade time to surgery decreased and outcome improved, most likely due to increased awareness and more timely referral. Early recognition is key to improve mortality and morbidity. However, early referral frequently makes it a challenge to recognize this heterogeneous disease in its initial stages. Signs and symptoms might be misleading or absent, while the most prominent skin marks might be in discrepancy with the position of the fascial necrosis. Gram staining and especially fresh frozen section histology might be a useful adjunct.
  
  
  
  Retrospective analysis of 3 year period. Non-transferred patients who presented with suspected necrotizing fasciitis are included. ASA classification was determined. Mortality was documented.
  
  
  
  In total, 21 patients are included. Most patients suffered from severe comorbidities. In 11 patients, diagnoses was confirmed based on intra-operative macroscopic findings. Histology and/or microbiotic findings resulted in 6/10 remaining patients in a change in treatment strategy. In total, 17 patients proved to suffer necrotizing fasciitis. In the cohort series 2 patients died due to necrotizing fasciitis.
  
  
  
  In the early phases of necrotizing fasciitis, clinical presentation can be ambivalent. In the present cohort, triple diagnostics consisting of an incisional biopsy with macroscopic, histologic and microbiotic findings was helpful in timely identification of necrotizing fasciitis.
authors.affiliation: Department of surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Falco
authors.identifier: 0000-0003-1462-6840
authors.initials: F
authors.lastname: Hietbrink
authors.affiliation: Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Lonneke G
authors.initials: LG
authors.lastname: Bode
authors.affiliation: Department of Surgery, Karolinska Institutet, Solna, Sweden.
authors.forename: Louis
authors.initials: L
authors.lastname: Riddez
authors.affiliation: Department of surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Luke P H
authors.initials: LP
authors.lastname: Leenen
authors.affiliation: Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Marijke R
authors.initials: MR
authors.lastname: van Dijk
mesh_terms: D000328:Adult; D001706:Biopsy / Q000379:methods*; D015897:Comorbidity; D003646:Debridement / Q000379:methods*; D042241:Early Diagnosis; D005205:Fascia / Q000382:microbiology / Q000473:pathology; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery; D005260:Female; D005629:Frozen Sections / Q000379:methods*; D006801:Humans; D008297:Male; D008828:Microbiological Techniques / Q000379:methods*; D009426:Netherlands / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D061665:Time-to-Treatment
keywords: Early recognition; Fresh frozen section; Histology; Necrotizing fasciitis; Triple diagnostics