Surgical treatment of 19 cases with vibrio necrotising fasciitis

Necrotising fasciitis and sepsis caused by the infection of vibrio is a rare but dangerous clinical emergency, with a mortality of 50-100%. Early diagnosis and surgical treatment may improve the prognosis significantly. However, valid emergency operation indications are scarce and need to be explored, which will be helpful for the early recognition and selection of operational procedures in patients with vibrio necrotising fasciitis.

We retrospectively analysed the patients with vibrio necrotising fasciitis admitted to the emergency department of our hospital from July 2000 to June 2009. The surgical treatment strategy was summarised in order to provide clinical evidence for surgical treatment of vibrio necrotising fasciitis.

A total of 19 cases of vibrio necrotising fasciitis were selected in our study. All the patients were living along the coast, and 68.4% had a history of chronic liver disease, 78.9% had a history of ethanol abuse, 52.6% had fever, 89.5% were complicated with septic shock and 31.6% progressed to multiple-organ dysfunction syndrome. Rapidly progressive local swelling and pain as well as skin superficial venous stasis were the early presentations of vibrio necrotising fasciitis, while skin ecchymosis, blisters or blood blisters, necrosis and subcutaneous crepitation were the presentations of the advanced stage. Seventeen patients received emergency incision and drainage, subcutaneous vein thrombosis, subcutaneous tissue necrosis, muscle and full-thickness necrosis observed in the operation, and necrotising fasciitis was confirmed by exploration or pathologic examination. Selective debridement and skin graft was performed to repair the wound after operation, and amputation was performed on two patients to close the wound. The average length of stay was 21.3 days (1-82 days), and eight patients died, with mortality being 42.1%.

Rapidly progressive local damage and acute deterioration of the patients are the most distinctive clinical manifestations of vibrio necrotising fasciitis. Recognition of the signs of local skin and tissue damage in early stage is crucial for early diagnosis and surgical intervention. Emergency incision and drainage, combined with selective debridement and skin graft, could improve the prognosis of the patients, and preserve the integrity of the patient's limbs as much as possible.