Necrotizing Fasciitis: A Vicious Soft Tissue Infection: Review Article

Abstract

Background: Necrotizing fasciitis is rapidly progressive, lethaldestructive inflammation with polymicrobial
infection and secondary necrosis. Though it is a disease described from the Hippocratic era, there is an increase in
the incidence of necrotizing fasciitis. The most important factors determining the outcome of the disease are early
diagnosis and aggressive debridement.
Materials and Methods: Cross-sectional descriptive study was conducted in a tertiary care teaching hospital’s
surgical ward. A total of 50 patients, diagnosed with necrotizing fasciitis based on the criteria set were included
in the study. After detailed clinical and laboratory evaluation, appropriate and adequate surgical and medical
interventions were administered and were followed to note the outcome.
Results: The majority of patients were over 40 years old and 74% of them were male. 72% of them had fever, 88% of
them had tenderness. 68% of the patients had involvement of the lower extremities. Trauma was the predominant
triggering factor and diabetes, the most commonly associated predisposing disease present in 72% of patients.
84% of the infections were polymicrobial and E. coli was isolated from 74% of them. 4 patients succumbed to the
disease and 6 patients needed amputations as a life-saving measure. Acidosis and hypoalbuminemia were the
most common independent predictive factors for mortality. Once sepsis is overcome and the granulation tissue is
formed, the wound is covered with an SSG or flap cover.
Conclusion: The aggressive and destructive course of necrotizing fasciitis could lead to morbidity and mortality.
Early recognition, aggressive debridement are the essential steps for recovery. Though broad-spectrum antibiotics
started as empirical therapy to avoid the catastrophe of septic shock, appropriate antibiotics should be started as
the disease is often polymicrobial. Acidosis, truncallocation, leucocytosis and decreased albumin were found to be
factors strongly associated with mortality.