Necrotizing fasciitis: Diagnosis Treatment and Review of the Literature

Background: Necrotizing fasciitis (NF) is characterized by rapidly spreading necrosis of soft tissue and fascia which can be fatal if it'is not managed properly.
Objective: The aim was discussing morbidity-mortality in NF patients to evaluate early diagnosis and reconstructive options.
Patients and Methods: 68 NF patients who were treated between 2000-2010 were assessed retrospectively for age, sex, localization, time elapsed between onset of symptoms, diagnosis, predisposing factors, characteristics of tissue defects, isolated microbiological agents, surgery, complications,and mortality rate. The mean age of 59 male, 9 female patients was 55.9 years.
Results: Of the 52 patients (76.4%) comorbidities such as diabetes, obesity, smoking, and corticosteroid use were present. The most common localization was perineum-inguinal region (70.5%). Time elapsed between onset of symptoms and diagnosis was 6.2 days. The mean size of tissue defect after debridement was 54.2cm2. The most common isolated microbiological agents were Escherichia coli, Enterococci,and Ps.aeruginosa. The most common reconstructive procedures were fasciocutaneous flap+STSG (57.3%). No major complication was observed except wound dehiscence and partial graft loss. The mortality rate was 13.2%.
Conclusion: The early diagnosis of NF may be lifesaving. When NF is suspected, early debridement should be performed. As soon as the infection and the spread of the necrosis are controlled, reconstruction should be considered.

Nekrotizan fasiit: Taný, Tedavi ve Literatürün Gözden Geçirilmesi

Giriþ: Nekrotizan fasiit (NF) yumuþak doku ve fasyalarýn hýzla yayýlan nekrozuyla karakterize, uygun tedavi edilmezse fulminan seyirli olabilen bir hastalýktýr. Diyabet, lokal travma, parafimozis, perirektal-perianal enfeksiyonlar, cerrahi giriþimler predispozan faktörlerdendir.
Amaç: Bu çalýþmanýn amacý, NF olgularýnda erken taný yöntemlerinin saptanmasý, tedavi ve rekonstrüksiyon seçeneklerinin gözden geçirilmesi ve morbidite-mortalitenin tartýþýlmasýdýr.
Hastalar-Yöntem: 2000-2010 yýllarý arasýnda NF tanýsý ile tedavi edilen 68 hasta yaþ, cinsiyet, lokalizasyon, taný konma süresi, predispozan faktörler, doku defekti özellikleri, izole edilen ajanlar, yapýlan cerrahi giriþim, komplikasyonlar ve mortalite oraný açýsýndan geriye dönük olarak incelendi. 59 erkek ve 9 kadýn hastanýn ortalama yaþý 55,9'di.
Bulgular: Hastalarýn 52’sinde (%76,4) diyabet, obezite, sigara, kortikosteroid kullanýmý gibi risk faktörleri mevcuttu. En sýk lokalizasyon perine ve inguinal bölgeydi (%70,5). Taný koyma süresi ortalama 6,2 gündü. Ýlk debridman sonrasý ortaya çýkan doku defekti ortalama 54,2 cm2 idi. En sýk izole edilen mikrobiyal ajanlar sýrasýyla Escherichia coli, Enterococci, Pseudomonas aeruginosa'ydý. Hastalarýn 54’ünde (%79,4) polimikrobiyal bir tablo söz konusuydu. Hastalara en sýk uygulanan rekonstrüktif cerrahi giriþim fasyokutanöz flep + kýsmi kalýnlýkta deri grefti ile onarýmdý (%57,3). Yara yeri ayrýlmasý, kýsmi greft kaybý gibi minör komplikasyonlar dýþýnda hiçbir majör komplikasyon izlenmedi. Mortalite oraný %13,2'yi.
Sonuç: NF olgularýnda erken taný hayat kurtarýcýdýr. NF’ten þüphelenildiði durumlarda erken debridman uygulanmalýdýr. Enfeksiyon tablosu ve nekrozun yayýlýmý kontrol edildikten sonra rekonstrüksiyon planlanmalýdýr.