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Necrotizing Fasciitis Originating in the Hand: A Systematic Review and Meta-Analysis
Georgios Christopoulos1, Alexandra Khoury1, Miguel Johnson1
1Queen Victoria Hospital, East Grinstead, UK.
Hand (New York, N.Y.)
|December 22, 2022
Summary
Necrotizing fasciitis (NF) of the hand is a severe infection with an 8% mortality rate and a 28% amputation rate. Early surgical intervention is crucial for improving outcomes in hand NF patients.
Area of Science:
- Infectious Diseases
- Surgical Pathology
- Public Health
Background:
- Necrotizing fasciitis (NF) is a severe, rapidly progressing soft tissue infection.
- NF of the hand presents unique challenges due to the complex anatomy and functional importance of the hand.
- Understanding treatment outcomes and prognostic factors is vital for effective patient management.
Purpose of the Study:
- To systematically review the treatment and prognosis of necrotizing fasciitis affecting the hand.
- To estimate overall mortality and amputation rates for hand NF.
- To identify predictors of amputation and mortality in hand NF cases.
Main Methods:
- Systematic literature search of the PubMed database.
- Inclusion of cohort studies and case reports.
- Pooled proportion analysis for mortality and amputation rates; logistic regression for predictor analysis.
Main Results:
- The review included 51 articles (54 patients in case reports, 107 in cohort studies).
- Overall amputation rate was 28%; overall mortality was 8%.
- Mortality was associated with age >54 years and diabetes mellitus; proximal necrosis correlated with amputation and mortality.
Conclusions:
- Early diagnosis and prompt, aggressive surgical debridement are critical for managing hand NF.
- Risk factors such as advanced age and diabetes mellitus necessitate heightened vigilance.
- Understanding prognostic indicators aids in optimizing treatment strategies and patient outcomes.
