A clinicopathological study of necrotizing fasciitis - An institutional experience

Objective: To describe the clinicopathological features in necrotizing fasciitis with evaluation of its clinical presentation, diagnostic criteria and mortality rate. Design: A case series, observational study. Place and Duration of Study: Kasturba Medical College Hospital, Manipal, India, from January 2003 to May 2005. Patients and Methods: All patients meeting clinical and/or histopathologic criteria for necrotizing fasciitis were included. Patients were studied with particular importance to the mode of presentation, associated co-morbid conditions, relevant investigations, histopathological report, modalities of treatment and final outcome. Results: A total of 38 patients were studied. The major cause of infection was idiopathic/primary. The average duration of symptoms at presentation was 10.07 days. The specific signs such as bullae and blistering were seen in 18 patients (47.3%). Of the infections, 19 (50%) were monomicrobial and 15 (39%) were polymicrobial. The most common complication seen was systemic sepsis with 9 patients (23.6%), of which 4 patients (10.5%) developed septicemic shock, 3 patients (7.8%) developed acute renal failure, 1 patient (2.6%) consolidation with pleural effusion and 2 patients (5.2%) had acute myocardial infarction. The mortality was 21%. Conclusion: The successful treatment of necrotizing fasciitis lies in early diagnosis and aggressive surgical debridement. Diabetes mellitus and other pre-morbid conditions increase the risk of mortality. The presence of bullae and blistering, foul smelling discharge and discolouration of skin raised the suspicion of necrotizing fasciitis. Findings at surgical exploration and skin biopsy are the only reliable means of diagnosis.