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Necrotising fasciitis: an entity revisited
Abstract:
Necrotising fasciitis is a disease that still carries a high morbidity and mortality despite our better understanding and advances in treatment since 1924 when Meleney first studied it. In our Department of Orthopaedics, this condition appears to be on the increase, and we therefore felt this entity deserved a restudy. Since 1985, 15 cases were seen, of which 10 were encountered in 1989. There were no recorded case prior to 1985. Our initial results show that the background and outcome parallel that of previous authors. Most were elderly with some form of underlying chronic disease. The duration from symptom onset to presentation was short, with many being in a state of septicaemia at the time of admission with fever, metabolic acidosis and marked leucocytosis. Repeated desloughings were common, and four ended up with some form of limb amputation. As with Meleney's study, the consistent pathogen cultured was B-haemolytic streptococcus. Our recommendation is that we should be more aware of this entity in view of its fulminant course, with early and aggressive surgical intervention being the keystone to management.
Insights
Necrotising fasciitis, a severe bacterial infection, is increasing in orthopaedics. Early surgical intervention is crucial for managing this aggressive condition, primarily caused by B-haemolytic streptococcus.
Area of Science:
- Infectious Diseases
- Surgical Pathology
- Orthopaedics
Background:
- Necrotising fasciitis presents significant morbidity and mortality.
- The condition appears to be increasing within orthopaedic departments.
- Previous studies, including Meleney's in 1924, highlight the disease's severity.
Purpose of the Study:
- To re-evaluate necrotising fasciitis in an orthopaedic setting.
- To analyze recent trends and outcomes of the disease.
- To identify key pathogens and effective management strategies.
Main Methods:
- Retrospective review of 15 necrotising fasciitis cases seen since 1985.
- Analysis of patient demographics, clinical presentation, and treatment outcomes.
- Microbiological culturing to identify causative pathogens.
Main Results:
- A notable increase in cases observed, with 10 cases in 1989 alone.
- Patients were predominantly elderly with chronic underlying diseases.
- Common presentations included septicaemia, metabolic acidosis, and leucocytosis.
- B-haemolytic streptococcus was consistently identified as the pathogen.
- Four patients required limb amputation due to disease progression.
Conclusions:
- Necrotising fasciitis requires heightened clinical awareness due to its rapid and severe course.
- Early and aggressive surgical debridement is paramount for successful management.
- Prompt recognition and intervention can improve patient outcomes.