Abstract

Introduction: Necrotizing fasciitis (NF) is a rapidly progressing, inflammatory infection of the superficial fascia with the secondary involvement of skin, subcutaneous tissue and muscle. High mortality and morbidity associated with NF makes it an emergency in which early debridement will have a favorable outcome. Hence it is important to study the clinic-pathological features and management of necrotizing fasciitis.

Methods and Results: This study was carried out in the Department of General Surgery, VIMSAR, (VSS Medical College & Hospital), Burla during November 2015 to October 2017, to evaluate the clinico-pathological features and management of necrotizing fasciitis.

Out of 11,000 cases admitted to the surgical ward during this period, 100 cases belong to necrotizing fasciitis. Mean age of presentation was 50 yrs, where, male was 85% and female was 15%.Etiology of trauma presents in 60%, spontaneous 35%, post op 5%.All the patients presented with in duration, inflammation and necrosis. 10 patients had wound crepitus. 20 patients presented with shock, 40 patients with tachycardia and Hypotension. 60 patient had leukocytosis (60%) among these 55 patient had more than 15400 cell/cm³. 54% of patient had sodium less than 135 mEq/l. Raised renal parameter was encountered 50% of patient. Kidney is most common organ involved. Diabetes mellitus was the most common predisposing factor present in 40%, followed by alcohol and smoking, PVD, HIV.20% had monomicrobial and 75% had poly microbial infection most common organism is pseudomonas, followed by staphylococcus, proteus, klebsiella, E.coli, citrobacter.

Aggressive fluid therapy, oxygen inhalation, correction of hypovolumia  and hypotension by plasma expanders, pressure agents and some time steroid in cases of hemodynamic instability, maintaining and monitoring renal function followed by higher generation antibiotics was the initial intervention, then early aggressive debridement and if required repeated debridement with surgical excision was carried out.95% underwent debridement, 70% skin grafting, 25% secondary suturing, 5% Amputation and overall mortality was 10%.

Conclusion: Thus study of the disease and its various attributes to understand the disease process better with refinement of various treatment modalities will definitely serve the patient and provide satisfactory control over this life threatening condition.