Necrotizing soft tissue infection: clinical characteristics and outcomes at a reconstructive center in Jilin Province

Abstract

Background: To investigate the clinical characteristics and treatment outcomes in necrotizing fasciitis (NF) patients in a reconstructive unit in northeastern China.

Methods: Medical records of patients diagnosed with and treated for NF in the extremities from November 2013 to December 2016 were retrospectively reviewed. Demographic data, clinical presentation, duration of signs and symptoms, location of infection, predisposing factors, causative microbiological organisms, laboratory risk indicator for necrotizing fasciitis (LRINEC) score, number of surgical debridements, length of hospital stay, treatments, and outcomes were recorded.

Results: A total of 39 consecutive patients were treated for severe NF (32 male and 7 female). Diabetes mellitus and blunt trauma were the most common risk factors (13 and 9 cases, respectively). The positive predictive value of the LRINEC score in NF diagnosis was 46.2%. Mean duration of signs and symptoms was 4.6 days. Staphylococcus aureus was the most commonly isolated bacteria (20 cases). All patients underwent their first debridement within 12 h of presentation (mean, 4.6 h). Mean number of surgical treatments was 2.8 (range, 2-5) per patient, including debridements. All patients survived, and mean length of hospital stay was 30.81 (range, 21-43) days. Three patients underwent limb amputation.

Conclusions: In our clinical experience, early detection and aggressive debridement are the cornerstones of NF treatment. Antibiotic therapy and intensive care support is essential in severe cases of NF. Anaerobic tissue culture and frozen section biopsy could be adopted as routine tests for diagnosis and decision-making in NF. These findings should inform clinical decisions about the treatment of individual patients with NF.

Keywords: Extremity; Necrotizing fasciitis; Surgical debridement; Treatment.

Fig. 1

A 57-year-old diabetic male experienced trauma to the right lower limb that resulted in immediate pain, swelling, and subcutaneous congestion. The patient did not seek treatment; therefore, the swelling and pain became widespread. The patient attended a local hospital where he underwent multifocal debridement and received antibiotic therapy, but his condition did not respond. Ten days later, the patient was transferred to our department for further definitive treatment. a the right lower limb was painful, with swelling and erythema. Multifocal debridement was performed, and necrotic tissue was exposed. b Foul smelling dishwater pus was present. c Aggressive debridement was performed revealing extensive necrosis of fascia and subcutaneous tissue. d Following surgery, the patient underwent negative pressure wound therapy and debridement at the bedside. e The clean wound bed was closed using sutures; the patient was discharged when all the sutures were removed, 2 weeks postoperatively

Fig. 2

A 37-year-old male suffering from aggressive pain and erythema of the right lower leg and foot for no identifiable reason was referred to our department for further definitive diagnosis and treatment after 1 day. a Swelling, subcutaneous congestion, necrosis and tenderness were found on the right foot and lower leg, with hypotension (85/53 mmHg), tachypnea (20 beats per minute), and tachycardia (113 beats per minute). b-c Emergency debridement was performed immediately after admission, and widespread necrosis was found. Debridement was repeated on day 4 and 9 after admission. d Skin graft was used to close the wound 1 month after the initial debridement

Fig. 3

A 48-year-old male suffering from pain, swelling, and subcutaneous congestion to the left lower limb and scrotum received antibiotic therapy and multifocal debridement at a local hospital, but his condition did not respond. Ten days later, and after two to four episodes of fever (39–40 °C), the patient was transferred to our department for further definitive treatment. a Multifocal debridement was performed on the left lower limb, and necrotic tissue was exposed. b Aggressive debridement was performed revealing extensive necrosis of fascia and subcutaneous tissue. c The patient underwent negative pressure wound therapy and debridement at the bedside. d The clean wound bed was closed using sutures and skin grafting