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Necrotizing fasciitis. Role of early surgical intervention
Shabir A Qazi1, Abdulmajeed A Mohammed, Elsanousi I Saber
1Department of General Surgery, Riyadh Medical Complex, Kingdom of Saudi Arabia. smmirza@hotmail.com
Objective:
To evaluate our experience of management of necrotizing fasciitis (NF) particularly the role of early and aggressive surgical intervention.
Methods:
This is a retrospective review of the cases affected by this disease and managed at Riyadh Medical Complex, Riyadh, Kingdom of Saudi Arabia, during 5 calendar years from 1996 through to 2000 (1416-1420 A.H). The preoperative and operative data was collected, and postoperative morbidity and mortality were analyzed.
Results:
A total of 25 cases of NF were treated during the 5-year period, 18 were males and 7 female. The majority of patients had perianal suppuration as the primary lesion, followed by groin area in drug addicts and only 2 cases were primarily in the upper limbs. Diabetes and drug addiction were the main predisposing factors. All but 3 infections were polymicrobial, with streptococci and acinobacter being the most frequent organisms. The mainstay of treatment depends on a high index of suspicion, aggressive early and repeated debridements and adequate antibiotic coverage. The overall mortality was 24% but the drastic reduction in mortality was observed with early surgical intervention.
Conclusion:
The results highlight the role of early diagnosis; prompt and aggressive surgical debridements are critical for improved survival.
