title: Early Diagnosis and Surgical Treatment for Necrotizing Fasciitis: A Multicenter Study.
abstract: BACKGROUND
  Necrotizing fasciitis (NF) is a group of relatively rare infections, usually caused by two or more pathogens. It affects the skin and subcutaneous tissues of lower and upper limbs, perineal area (Fournier's gangrene), and the abdominal wall. Early diagnosis and aggressive surgical management are of high significance for the management of this potentially lethal disease.
  
  
  METHODS
  We conducted a retrospective study in patients who presented, during the last decade, at four University Surgical Departments in the area of Athens, Greece, with an admission diagnosis of NF. Demographic, clinical, and laboratory data were gathered, and the preoperative and surgical treatment, as well as the postoperative treatment was analyzed for these patients.
  
  
  RESULTS
  A total of 62 patients were included in the study. The mean age of patients was 63.7 (47 male patients). Advanced age (over 65 years) (P< 0.01) and female sex (P= 0.04) correlated significantly with mortality. Perineum was the mostly infected site (46.8%), followed by the lower limbs (35.5%), the upper limbs, and the axillary region (8.1%). Diabetes mellitus was the most common coexisting disease (40.3%), followed by hypertension (25.8%) and obesity (17.7%). The most common symptom was local pain and tenderness (90.3%). Septic shock occurred in eight patients (12.9%) and strongly correlated with mortality (P< 0.01). Laboratory data were used to calculate the LRINEC score of every patient retrospectively; 26 patients (41.9%) had LRINEC score under 6, 20 patients (32.3%) had LRINEC score 6-8, and 16 patients (25.8%) had LRINEC score >9. Surgical debridement was performed in all patients (mean number of repeated debridement 4.8), and in 16 cases (25.8%) the infected limb was amputated. The mean length of hospital stay was 19.7 days, and the overall mortality rate of our series was 17.7%.
  
  
  CONCLUSIONS
  Diagnosis of NF requires high suspect among clinicians, as its clinical image is non-specific. Laboratory tests can depict the severity of the disease; therefore, they must be carefully evaluated. Urgent surgical debridement is the mainstay of treatment in all patients; the need of repetitive surgical debridement is undisputed.
authors.affiliation: 3rd Department of Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital , Athens , Greece.
authors.forename: Evangelos P
authors.initials: EP
authors.lastname: Misiakos
authors.affiliation: 3rd Department of Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital , Athens , Greece.
authors.forename: George
authors.initials: G
authors.lastname: Bagias
authors.affiliation: 4th Department of Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital , Athens , Greece.
authors.forename: Iordanis
authors.initials: I
authors.lastname: Papadopoulos
authors.affiliation: 4th Department of Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital , Athens , Greece.
authors.forename: Nickolaos
authors.initials: N
authors.lastname: Danias
authors.affiliation: 3rd Department of Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital , Athens , Greece.
authors.forename: Paul
authors.initials: P
authors.lastname: Patapis
authors.affiliation: 2nd Propedeutic Department of Surgery, Medical School, National and Kapodistrian University of Athens, Laikon General Hospital , Athens , Greece.
authors.forename: Nickolaos
authors.initials: N
authors.lastname: Machairas
authors.affiliation: 2nd Propedeutic Department of Surgery, Medical School, National and Kapodistrian University of Athens, Laikon General Hospital , Athens , Greece.
authors.forename: Theodore
authors.initials: T
authors.lastname: Karatzas
authors.affiliation: 4th Department of Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital , Athens , Greece.
authors.forename: Nickolaos
authors.initials: N
authors.lastname: Arkadopoulos
authors.affiliation: 1st Propedeutic Department of Surgery, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital , Athens , Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Toutouzas
authors.affiliation: 1st Propedeutic Department of Surgery, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital , Athens , Greece.
authors.forename: Nickolaos
authors.initials: N
authors.lastname: Alexakis
authors.affiliation: 1st Propedeutic Department of Surgery, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital , Athens , Greece.
authors.forename: Manousos N
authors.initials: MN
authors.lastname: Konstantoulakis
authors.affiliation: 1st Propedeutic Department of Surgery, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital , Athens , Greece.
authors.forename: George
authors.initials: G
authors.lastname: Zografos
authors.affiliation: 4th Department of Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital , Athens , Greece.
authors.forename: Vasilis
authors.initials: V
authors.lastname: Smyrniotis
authors.affiliation: 2nd Propedeutic Department of Surgery, Medical School, National and Kapodistrian University of Athens, Laikon General Hospital , Athens , Greece.
authors.forename: Gregory
authors.initials: G
authors.lastname: Kouraklis
authors.affiliation: 3rd Department of Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital , Athens , Greece.
authors.forename: Anastasios
authors.initials: A
authors.lastname: Machairas
keywords: Fournier’s gangrene; LRINEC score; VAC therapy; debridement; necrotizing fasciitis