Necrotizing fasciitis: a preventable disaster

Abstract

Twenty-eight cases of necrotizing fasciitis (NF) were treated in 27 patients. Most commonly these infections were caused by perineal disease, operative procedures, and cutaneous ulcers. Associated chronic diseases were present in 21 patients. Postoperative fasciitis occurred when prophylactic antibiotics were omitted or used inappropriately during clean-contaminated or contaminated procedures and when primary skin closure was done in the presence of intra-abdominal contamination. All but four infections were polymicrobial. The overall mortality rate was 73% (20 of 27). Death was due to persistent would sepsis in nine, systemic septic complications despite apparent local control of the infection in nine, and myocardial infarction in two patients. Five of seven survivors had NF limited to one region (leg, perineum, or abdomen). Only 2 of 15 patients survived when more than one debridement was necessary to control ongoing wound necrosis. Eleven of 12 patients who had a delay in treatment for more than 12 hours died. These results suggest that prompt recognition and treatment of NF are essential for survival. The presence of chronic debilitating diseases may contribute to the uncontrollable nature of both local and systemic infection, further emphasizing the need for early diagnosis. Postoperative fasciitis is potentially preventable by strict adherence to the principles for management of contaminated procedures.