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Necrotizing fasciitis is on the right end of the spectrum with associated high morbidity and mortality. Although the descriptions of this can be dated to the times of Hippocrates, the mortality associated with the disease remained high. Early surgical debridement without any controversy is accepted as the single best prognostic indicator, but due to the masked and overlapped clinical findings relying on the clinical prowess of the treating surgeon is questionable. Due to which we need to have an objective method of assessment, many researchers have assessed the use of various biochemical, imaging, and histopathological investigation, which has been reviewed in the same.
Necrotizing fasciitis is on the right end of the spectrum with associated high morbidity and mortality. Although the descriptions of this can be dated to the times of Hippocrates, the mortality associated with the disease remained high. Early surgical debridement without any controversy is accepted as the single best prognostic indicator, but due to the masked and overlapped clinical findings relying on the clinical prowess of the treating surgeon is questionable. Due to which we need to have an objective method of assessment, many researchers have assessed the use of various biochemical, imaging, and histopathological investigation, which has been reviewed in the same.
Necrotizing fasciitis is an uncommon, rapidly progressive, often aggressive bacterial infection that causes extensive necrosis of the subcutaneous tissue and fascia, relatively sparing the muscle and skin tissues. Rapid diagnosis of the disease is mandatory because the delay in initiation of aggressive treatment negatively influences the outcome. Specific clinical signs may not be always present, which makes an accurate and timely diagnosis difficult. Based on the literature, this article presents a review of the historical background, etiology, pathophysiology, clinical findings, diagnostic strategies, treatment and prognosis of the disease.
<b><br>Introduction:</b> Necrotizing fasciitis (NF) is a rare, rapidly progressing infection of the skin and subcutaneous tissue. NF can lead to massive tissue necrosis, resulting in sepsis, septic shock and death. In this disease, it is important to quickly diagnose and implement appropriate treatment.</br> <b><br>Aim:</b> Analysis of the diagnostic and therapeutic process in two clinical cases and a review of the literature on the methods of diagnosis and treatment of necrotizing fasciitis.</br> <b><br>Material and methods:</b> The medical data of two patients hospitalized in the St Alexander Hospital in Kielce from December 2022 to June 2023 due to necrotizing fasciitis were analyzed. Also literature search across PubMed, Medline and Research Gate databases from 2000 up to 2023 was performed. We reviewed English literature according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The following keywords were used: necrotizing fasciitis, etiopathogenesis, pathophysiology, management.</br> <b><br>Results:</b> The research group consisted of two male patients with NF after trauma, in different parts of the body. Based on the clinical examination, the results of laboratory and imaging tests, a diagnosis was made and appropriate treatment was initiated. Despite the applied treatment, one patient died as a result of progressive multiple organ failure.</br> <b><br>Conclusions:</b> Despite advances in diagnosis and treatment, including universal access to antibiotics, necrotizing fasciitis still cause high mortality. The microbiological complexity of the majority of cases and non-specific symptoms make the diagnostic and therapeutic process difficult. Taking into account necrotizing fasciitis each time in the differential diagnosis of inflammation of the skin and subcutaneous tissue, especially based on trauma, will allow to reduce morbidity and mortality in this disease.</br>
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