Necrotizing fasciitis is a rapidly progressive fulminant infection of the deep fascia and subcutaneous tissue commonly involving extremities, perineum, scrotum, penis, abdominal wall. It is associated with significant morbidity and mortality. Trauma is the most commonly identified etiology. Elderly and immunocompromised patients are the most affected. Early diagnosis and differentiation from other non-necrotising skin and soft tissue infections is needed because delay in surgical debridement leads to larger area of necrosis and higher chance of mortality. Diagnosis is dependent on clinical features like disproportionate pain, tenderness beyond skin involvement, systemic signs of toxicity like fever and tachycardia, erythema, edema, presence of bullae etc. We present our experience with 45 cases of necrotizing fasciitis of the extremities with respect to etiology and triggering factors, clinical presentation, laboratory findings and treatment outcomes in the rural Indian setting. This is a retrospective observational study conducted with the aim of analyzing the factors influencing morbidity and mortality of necrotizing fasciitis. Demographic data, presence of co-morbidities, time interval from onset of symptoms to surgical intervention, nature of organisms isolated, derangement of laboratory indicators like haemoglobin, total WBC count, blood urea,  serum creatinine, sodium levels were collected and analysed for their influence on  duration of hospital stay and area of skin necrosis that needed grafting. It was found that delay in presentation was associated with larger area of necrosis which was statistically significant. However no association was found between age, sex, site of involvement, presence of co-morbidities, history of local application of an irritant and area of necrosis.

Keywords: necrotizing fasciitis, extremities, area of necrosis, skin grafting

1. Wilson B. Necrotizing fasciitis. Am J Surg. 1952;18:416–31. [PubMed]
2. Evangelos P. Misiakos, George Bagias,  Paul Patapis, Dimitrios Sotiropoulos,  Prodromos Kanavidis, and Anastasios Machairas: Current Concepts in the Management of Necrotizing Fasciitis; Front Surg. 2014; 1: 36. Published online 2014 Sep 29. Prepublished online 2014 May 31. doi:  3389/fsurg.2014.00036 PMCID: PMC4286984
3. Mark A Malangoni, Christopher R McHenry: soft tissue infection; ACS surgery- principles and practice; 7^th edition, 2014,pp414-28.
4. Elliott D, Kufera JA, Myers RA. The microbiology of necrotizing soft tissue infections. Am J Surg. 2000;179:361–6. doi: 10.1016/S0002-9610(00)00360-3.  [PubMed][Cross Ref]
5. Bosshardt TL, Henderson VJ, Organ CH. Necrotizing soft tissue infections. Arch Surg. 1996;131:846–54. doi: 10.1001/archsurg.1996.01430200056011. [PubMed] [Cross Ref]
6. Buchholz J, Jeske M, Kuhnen C, et al. (1997) Necrotizing fasciitis of extremities: clinical and histological examinations. Br J Surg 84–7
7. Shah KA, Kumar NB, Gambhir RPS, et al. Integrated clinical care pathway for managing necrotizing soft tissue infections. Ind J Surg. 2009;71:254–7. doi: 10.1007/s12262-009-0076-6. [PMC free article][PubMed][Cross Ref]
8. Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (laboratory risk indicator for necrotizing fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004;32:1535–41. doi: 10.1097/01.CCM.0000129486.35458.7D.  [PubMed][Cross Ref]
9. Ayman El-Menyar, Mohammad Asim, Insolvisagan N. Mudali, Ahammed Mekkodathil, Rifat Latifi, and Hassan Al-Thani: The laboratory risk indicator for necrotizing fasciitis (LRINEC) scoring: the diagnostic and potential prognostic role; Scand J Trauma Resusc Emerg Med. 2017; 25: 28. Published online 2017 Mar 7. doi:  1186/s13049-017-0359-z
10. Misiakos EP,Bagias G, Papadopoulos I, Danias N, Patapis P, Machairas N,  Karatzas T, Arkadopoulos N, Toutouzas K, Alexakis N, Konstantoulakis MN,  Zografos G, Smyrniotis V, Kouraklis G,  Machairas A. Early Diagnosis and Surgical Treatment for Necrotizing Fasciitis A Multicenter Study; Front Surg. 2017 Feb 7;4:5. doi: 10.3389/ fsurg.2017.00005. eCollection 2017.
11. Hodgins N,Damkat-Thomas L, Shamsian N, Yew P, Lewis H, Khan K: Analysis of the increasing prevalence of necrotising fasciitis referrals to a regional plastic surgery unit: a retrospective case series. J Plast Reconstr Aesthet Surg. 2015 Mar;68(3):304-11.
12. Anaya DA,McMahon K, Nathens AB, et al. Predictors of mortality and limb loss in necrotizing soft tissue infections. Arch Surg 2005; 140: 151-8.

Dr K.Karthik Raja. M.S.

Lecturer in Surgery, Department of Surgery, Rajah Muthiah Medical College and Hospital,

Annamalai University, Chidambaram, Tamilnadu, India

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.