Necrotizing fasciitis: a comparative analysis of 56 cases

Abstract

Background: The term necrotizing fasciitis (NF) is now used in a generic sense to include all diffuse necrotizing soft-tissue infections except gas gangrene. It is a synergistic, polymicrobial soft-tissue infection associated with rapid progression, extensive necrosis, profound systemic toxemia, considerable morbidity and a high mortality rate. Although the disease is no respecter of age and affects a wide age group, adults are known to be more commonly affected than children.

Aims: To highlight the differences and similarities in the modes of presentation and results of intervention of NF in children and adults.

Patients and methods: A four-year prospective descriptive analysis of all consecutive patients with NF (excluding cancrum oris and Fournier's gangrene) treated at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, from January 2001 to December 2004.

Results: A total of 56 patients were treated of which 32 (57.1%) were children < or = 15 years, while the remaining 24 (42.9%) were adults aged >15 years. There were 31 males and 25 females, giving the male-to-female ratio of 1.2:1; the corresponding ratios for children and adults were 1.7:1 and 1.1:2, respectively. The age ranged from six days to 70 years (mean 19.9 years). Trauma and minor skin infections were the main precipitating factors. The total body surface area (BSA) involved ranged from 1-16% (children 2-16%, adults 1-7%) with a mean of 4.3% (children 5.9%, adults 2.7%). The trunk was the most commonly involved anatomical region of the body (50.0%) in children, while in adults it was the lower limb (54.2%). In both children and adults, infection was mainly polymicrobial. The most common mode of wound resurfacing was by second intention in children (46.9%) and split-thickness skin grafting (STSG) in adults (37.5%). Septicemia was a common complication in both age groups. Mortality was 9.4% and 16.7% among children and adults, respectively.

Conclusion: NF is more common in children than adults in northwestern Nigeria. Early recognition, aggressive surgical treatment and supportive therapy remain the essential keys to success.