How to manage necrotizing fasciitis?
Necrotizing fasciitis, a rapidly spreading soft tissue infection, is a rare but life-threatening condition that can affect the skin and soft tissues in any part of the body. Necrotizing fasciitis can occur after minor trauma or after surgical procedures, and can also occur with no any obvious inciting incident. Studies on its incidence estimate 4 cases per 100,000 patients, and incidence does seem to be increasing. The reasons behind this increase are likely to be multifactorial, and include increased diagnostic accuracy, increased reporting, increasing age and comorbidities of the population in general, and increased rates of virulent infectious microorganisms. Mortality rates range from 4% to 40%, with most studies reporting a mortality of 15% to 20% overall. Factors associated with increased mortality include age; comorbidities such as diabetes, congestive heart failure, and gout; delay in antibiotic administration; delay in time to surgical intervention; and infections by Vibrio vulnificus or a Clostridial species. Early diagnosis, control with broad spectrum antibiotic therapy and early surgical debridement, all of which are crucial in the prognosis of these patients, are of vital importance for proper treatment. In this lecture, Nikolaos G. Danias explains the etiology of this serious disease, its treatment, and the suitable surgical management to reduce mortality in these serious patients and improve their prognosis.
