壊死性筋膜炎に関する洞察：三次ケア病院における前向きパイロットスタディ
1Department of General Surgery, Saveetha Institute of Medical and Technical Sciences, India.
Introduction:
Necrotising fasciitis, commonly referred to as "flesh-eating disease," is a rapidly spreading soft tissue infection characterised by extensive necrosis of the skin, subcutaneous tissue, and fascia while sparing the underlying muscle. Despite its low overall incidence, it is a significant soft tissue infection due to its rapid spread and associated high mortality risk.
Materials And Methods:
This prospective pilot study aims to analyse 25 consecutive cases of necrotising fasciitis to assess various aspects, including age and sex incidence, microbial flora, role of co-morbidities in prognosis, and overall outcome. We conducted a descriptive study involving 25 patients aged 18-84 years diagnosed with necrotising fasciitis over a 6-month period (January 2022 to June 2022) at Saveetha Medical College.
Results:
Of the 25 patients treated, 21 (84%) were male and 4 (21%) were female, resulting in a male-to-female ratio of 5.25. The age ranged from 18 to 84 years (Mean age: 50.24 ± Standard deviation, SD=14.175). Trauma was identified as the main precipitating factor in approximately 40% of cases, while Diabetes Mellitus (40%) emerged as the most common co-morbidity. Lower limb involvement was predominant in both male and female patients. The infection was monomicrobial in 32% of cases (Enterococci 16% + Bacteroides 16%) and poly-microbial in 68% with Streptococcus pyogenes + Escherichia coli being the most common organism combination. Wound debridement followed by split skin graft was the most common treatment modality (84%), with the number of debridement sessions varying based on infection severity (corresponding with higher LRINEC scores). Prolonged hospital stay was the most common complication, observed in 52% of cases.
Discussion:
Our analysis revealed that necrotising fasciitis is more prevalent in individuals aged over 50 years with a male predominance. Streptococcus pyogenes with Escherichia coli was the predominant microflora, and Diabetes Mellitus emerged as the most common comorbidity. Early recognition, prompt control of diabetes mellitus, aggressive surgical treatment, and supportive therapy are essential steps in managing necrotising fasciitis.
