Necrotizing fasciitis. Importance of roentgenographic studies for soft-tissue gas

Twenty-six patients with necrotizing fasciitis were treated during a nine-year period. Twenty-one (81%) had diabetes mellitus and 19 (73%) had gas in their soft tissues from nonclostridial infection. Although crepitation was found by physical examination in only five patients, roentgenographic examination of the involved site disclosed gas in every patient in whom it was subsequently found at surgery. Previous studies have not used roentgenography to search for soft-tissue gas. The 21 diabetic patients in our series had a mortality of 19%, the lowest yet reported. This suggested that roentgenographic study of cases with fasciitis permits earlier diagnosis and favorably affects outcome.