Necrotizing soft tissue infections: the surge of an old disease in a modern era.

Abstract

Background: Necrotizing soft tissue infection is an uncommon surgical condition characterized by rapidly spreading necrosis of the skin, subcutaneous tissue and adjoining fascia often associated with gas formation. It is frequently a polymicrobial infection and the combination of aerobic and anaerobic bacteria contributes to the quick progression and severity of the disorder. A great deal of attention has been directed at classifying these infections by clinical appearance, tissue level affected and microbiological findings.
Material and Methods: Six patients with necrotising soft tissue infections were admitted through the Accident and Emergency unit, from October 2006 to March 2007. They were studied for the etiology, bacteriology, treatment given and the final outcome.
Results: The predisposing factor in four patients was trauma and in five patients the precipitating factor was sepsis following treatment from unorthodox medical practitioners commonly as a result of ignorance and or financial constraints. The anatomical sites involved were the lower limbs, the neck and anterior chest wall. One patient had bilateral lower limb involvement. All the patients had severe local pain, swelling and foul smelling discharge from extensive ulcerations. Four patients had crepitations subcutaneously, blistering and extensive skin necrosis. Systemic toxicity developed prominently in one
patient.
Conclusion: Despite aggressive wound debridement and parenteral antibiotic cover, necrotizing soft tissue infection in our environment is still characterized by severe morbidity and high mortality

Keywords: Necrotizing soft tissue infection, Necrotising fascitis, Polymicrobial infection, Debridement.

Nigerian Journal of Plastic Surgery Vol. 3 (2) 2007: pp. 36-41