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Identifying And Treating Necrotizing Fasciitis (Visit this link)
Identifying and treating Necrotizing Fasciitis. AAOS Paper No: 033 Wednesday, March 22, 2006 Shaul Beyth, MD Jerusalem Israel (n) Allon E Moses, MD Jerusalem Israel (n) Meir Liebergall, MD Jerusalem Israel (n) Amos Peyser, MD Jerusalem Israel (n) Signs and symptoms of necrotizing faciitis are misleading resulting in delayed diagnosis therefore a high index of suspicion is mandatory. Surgical treatment of potentially fatal necrotizing fasciitis (NF) is often delayed due to late diagnosis. Identifying distinguishing characteristics may improve management of this medical emergency. A retrospective analysis of 68 patients with NF between 1990 and 2004. Our study focused on 28 (34%) patients with limb involvement. We review cases from initial medical encounter to resolution, especially focusing on clinical signs and symptoms, time to diagnosis, treatment and outcome. Age ranged from 1-83 years (average 53.6), 68% were males, 80% had underlying diseases (44% diabetes). Only 25% presented with fever, 25% had hypotention. The most prominent finding (84% of patients) was severe pain. 72% had skin erythema and only one patient had palpable crepitus. Only 25% were correctly diagnosed at initial presentation, leading to delayed surgical treatment (64% beyond 24 hours, 40% beyond 48 hours). Streptococci were isolated in 40% and polymicrobial infection was noted in 28%. Only 3 cultures grew anaerobic bacteria, air was noted in the radiographs of 6 patients. Hospitalization averaged 32.4 days; amputation rate was 12%, as was multi-organ failure. Mortality was 32%. In our 28 patients with limb NF, we found that patients' signs and symptoms are misleading and result in delayed diagnosis. Many of our patients had underlying diseases predisposing to infection. Severe, sometimes excruciating pain, disproportionate to the initial objective findings seems to be a clue to diagnosis. A high index of suspicion in patients with limb infection and severe pain is mandatory for early diagnosis and treatment.
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Added: Sun Apr 02 2006
