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A Clinicopathological Study of Necrotizing Fasciitis

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Author(s): Madhumita Mukhopadhyay, Anil K Saha, Ranu Roy Biswas and Swapan Biswas

Journal: Al Ameen Journal of Medical Sciences
ISSN 0974-1143

Volume: 04;
Issue: 01;
Start page: 6;
Date: 2011;
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Keywords: Necrotizing fasciitis | Clinico-pathological study | Surgical debridement | Outcome

ABSTRACT
Background: Necrotizing fasciitis is a relatively common infection with high morbidity and mortality, as they often present late in their clinical course. Quick and aggressive surgical treatment improves survival and decreases hospital stay. Methods: A prospective study of 50 consecutive patients of necrotizing fasciitis who were admitted in our hospital over a period of 342 days between May 2007 and April 2008. The study includes clinical presentation, biochemical parameters, bacteriology, predisposing factors, associated co-morbid conditions, time interval between admission and first surgical intervention and outcome of this life threatening infection. Results: 50 patients of necrotizing fasciitis were studied over a period of 342 days. The mean age of the patients were 44.5 ± 8.36 years and male: female ratio was 3.17 : 1. Diabetes mellitus was the most common co-morbid condition (42%). Alcoholism was the commonest addiction (34%). Regarding predisposing conditions majority (48%) of the cases were idiopathic. History of trivial trauma was present in (38%) patients. Mean duration of symptoms was 5.16 ± 0.902 days. Perineum was the commonest site involved (52%) followed by the lower extremity (40%). The commonest bacteria isolated was E.coli (42%). The culture was polymicrobial in (78%) patients. Mean number of surgical debridement were 3.84 ± 0.809. Secondary surgical procedures included mobilization and suturing (48%) and skin grafting (42%). Average duration of hospital stay was 33.04 ± 7.99 days. Mortality was 10%. Conclusions: Necrotizing fasciitis is more common in middle aged males. Diabetes mellitus is the most common co-morbid condition associated with necrotizing fasciitis. The perineum is commonly affected. The presence of multiple co-morbid conditions reduces the survival. Early diagnosis and aggressive surgical debridement reduces mortality.
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