Necrotizing Fasciitis

Necrotizing Fasciitis

“…The mortality of NF has been reported in recent studies to be approximately 25%, but it is higher in some reports (10,11,18,19,25,43 (4,49,50,(78)(79)(80) …”

Necrotizing Soft Tissue Infection of the Foot: A Case Report

“…3 The clinical course of NSTI is often not as rapid as would be expected from the media reports of "flesh-eating bacteria." Although fever and tachycardia may begin at 24 hours, the pathognomonic features of skin sloughing, bullae, and cutaneous gangrene do not usually occur until the fourth or fifth day.…”

“…The most common factors predisposing patients to NSTI are diabetes mellitus, peripheral vascular disease, obesity, alcohol abuse/hepatic disease, malignancy, immunosuppressant therapy, and intravenous drug abuse. 3,8,10,11 Portals of entry for NTSI include sites of pre-existing ulcerations, recent surgical wounds, traumatic wounds, sites of subcutaneous insulin injection or illicit drug injection, and minor abrasions, burns, lacerations, or insect bites. 8,11 In urban hospital settings, the incidence of NSTI secondary to intravenous injection of illicit drugs has been increasing in recent years, necessitating the need to question the patient's social history.…”

“…The most common presenting signs of NSTI are nonspecific signs of inflammation such as erythema, edema, and pain. Wong, et al, 3 describe a "triad" of exquisite pain (97.8% of patients), swelling (92.1%), and fever (79.8%). In their matched consecutive case series of 21 NSTI cases and 21 non-NSTI controls, Wall and colleagues 13 identified tense edema (38% vs 0%, p=0.003) and bullae (24% vs 0%; p=0.049) as the most specific physical findings.…”

“…While amputation was not found to reduce mortality, patients who underwent amputation had to undergo fewer operations to control the infection and to achieve wound coverage (2.59 compared with 3.45; p<0.05). 3 In their series, Bosshardt, et al, 12 employed triple antibiotic therapy consisting of ampicillin or high dose penicillin G, an aminoglycoside, and clindamycin or metronidazole.…”