Abstract

Introduction

Necrotizing Fasciitis (NF) is a relatively common, rapidly progressing infection affecting the superficial fascia and subcutaneous tissue, accompanied by severe systemic toxicity and multiorgan failure. The rate of spread is directly proportional to the thickness of the subcutaneous tissue. Necrotizing fasciitis moves along the fascial plane.^[1,2].

 Early diagnosis of case with necrotizing fasciitis is always a challenge for surgeons because of the vague presentation, lack of clear boundaries and palpable limits between viable, nonviable and infected tissue. There is a layer of necrotic tissue which is not walled off by an inflammatory reaction. Overlying skin has a relatively normal appearance in early stages of infection and visible degree of involvement is substantially less than actual pathology.  Management of this disease still remains suboptimal with mortality rates of approximately 30%.

The term necrotising fasciitis was first used by Wilson^[3] in 1952 to describe the most consistent feature of the infection, necrosis of the fascia and subcutaneous tissue with relative sparing of the underlying muscle. It can progress rapidly to systemic toxicity and even death if not promptly diagnosed and treated. Once suspected, management should consist of immediate resuscitation, early surgical debridement, and administration of broad spectrum intravenous antibiotics.

It has been a practice of ignorant people mostly belonging to lower and middle socioeconomic groups to apply Ayurvedic balms for body aches and minor cuts. A Counterirritant is an agent that causes irritation or a mild inflammation of the skin to relieve symptoms of a deep seated inflammatory process. The balms contain counterirritants like Gaultheria, Eucalyptus Globulus, camphor, menthol, cajuput oil, mint oil and clove oiletc. The authors believe that some of the contents of these balms may be the etiological factor for Necrotizing fasciitis. A retrospective study was conducted in tertiary Government teaching hospital, South India to find out any association between applications of these balms in the causation of NF.

A retrospective cohort study, also called a historic cohort study, is a longitudinal cohort study that studies a cohort of individuals that share a common exposure factor to determine its influence on the development of a disease, and are compared to another group of equivalent individuals that were not exposed to that factor.