Managing necrotising fasciitis to reduce mortality and increase limb salvage

Abstract

Objective: Necrotising fasciitis is a rare soft-tissue infection with a high mortality rate. In this paper we describe our management protocol for necrotising fasciitis, focused on surgical approaches, which increased patients' survival rate.

Method: Between March 2009 and December 2014, patients suspected of having necrotising fasciitis (based on laboratory and MRI examinations), underwent management for the infection. A patient suspected of having necrotising fasciitis had surgical exploration performed within eight hours. Patients underwent serial debridement every 24-72 hours until infection had been fully eradicated, after which reconstructive surgery was considered.

Results: A total of 34 patients underwent management for necrotising fasciitis, 31 of which had the infection confirmed. From this group, the 18 patients who underwent free flap reconstructive surgery were included in the study, nine of which were female with a mean age of 54.3 (range: 28-77) years. The patients underwent 2-5 repeat debridements (mean: 3.5). Reconstructive procedures were latissimus dorsi (LD) myocutaneous flap in 11 patients, and latissimus dorsi chimeric flap in six patients; the remaining patient received an latissimus dorsi myocutaneous flap, an latissimus dorsi perforator flap and an anterolateral thigh flap simultaneously. Patients were discharged from hospital and returned to daily life three weeks after the final procedure. The mean length of follow-up was 34.8 months (range: 12-60 months). All 18 patients survived.

Conclusion: With multidisciplinary management, the challenge of necrotising fasciitis can be overcome without risk of mortality risk.

Keywords: chimeric flap; debridement; myocutaneous flap; necrotising faciitis; soft tissue infection.