Early Surgical Escalation and Structured Multidisciplinary Pathways Improve Limb-Salvage Outcomes in Necrotizing...

Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening soft-tissue infection characterized by extensive fascial necrosis and systemic toxicity. Reported mortality ranges from 20% to 40%, driven largely by diagnostic delay. Orthopedic units carry a disproportionate burden, particularly for lower-limb disease. This two-cycle quality improvement project (QIP) examined whether structured diagnostic pathways and early multidisciplinary escalation could reduce time to surgery and improve limb-salvage outcomes.

Twenty-seven patients with confirmed or suspected NF were managed across two sequential audit cycles at a tertiary orthopedic center (Cycle 1, n = 14; Cycle 2, n = 13). Mean age was 52.1 ± 11.3 years; 80% had lower-limb involvement, and 70% had diabetes mellitus. Following QIP implementation, median time to surgical decision fell from 11.5 ± 3.2 to 6.8 ± 2.1 hours (P = 0.002). Recovery rates rose from 14.3% to 84.6% (P < 0.001) and major amputation rates declined from 35.7% to 15.4% (P = 0.04). Documentation of Laboratory Risk Indicator for Necrotizing Fasciitis scores and finger-sweep testing improved significantly. In-hospital mortality remained comparable (21.4% vs. 23.1%).

A structured, protocol-driven approach to NF management - encompassing mandatory diagnostic documentation, early senior involvement, and multidisciplinary team activation - substantially improves surgical timeliness and limb-salvage rates. Mortality reduction may require parallel optimization of perioperative sepsis management and critical care pathways.