Necrotizing fasciitis: A deadly disease

Abstract

Background: Knowledge of the diagnosis, cause, course and required treatment of this deadly disease among physicians and surgeons around the world is limited.
Methods: A study was undertaken at University Teaching Hospital (UTH), Lusaka Zambia to review the incidence, associated pathology, management given, and outcomes, comparing 2 sequential years. This study covered a transitional phase at the end of 2003 in which adequate surgical procedures and management of abscesses and Necrotizing Fasciitis (NF) were emphasized.
Results: A total of 126 patients had primary surgery, 81 in 2003 and 45 in 2004. There were 6 and 1 secondary operations respectively. The percentage of sloughectomy for NF increased from 66.7% in 2003 to 88.9 % in 2004 and incision and drainage dropped from 16% to 4.4%. The male to female sex ratio was 1.6 to 1. The disease primarily affected young patients with an average age 29 years 3 months in 2003 and 33 years 7 months in 2004. Seventeen (20.9%) of patients admitted in 2003 and 10 (22.2%) of those seen in 2004 died. Those patients who died were desperately ill on arrival and most were preterminal or moribund.
Conclusion: The marked reduction in cases in 2004 may have been due to better surgical care of abscesses and the increase in sloughectomy indicated better understanding of this vital operation. Total excision of all necrotic tissue can lower mortality further, but early access and diagnosis can have a profound effect on outcomes.