STUDY OF 24 CASES OF NECROTISING FASCIITIS FOR PREDISPOSING FACTOR AND THEIR MANAGEMENT

Background & Method: Whole study was done in our Institute with patient attending outdoor and emergency department of INDEX MEDICAL COLLEGE HOSPITAL AND RESEARCH CENTER. Collection of data –From each patient thorough history was taken, clinically examination was done, vitals where recorded, systemic examination was done and local examination of the lesion was done. Every patient base line investigation of complete blood count, renal function test liver function test serum electrolyte blood grouping serology of of HIV and Hbs antigen were done. Result: Most of the Patient was in the age group of 40years to 60 years. Conclusion: A total of 24 cases of necrotizing fascitis were studied over 1st June 2019 to 25 march 2020. Greater number of cases was reported among middle aged group of 40years to 60 years. Rarity of disease among pediatric age groups affected person were mostly male -21, female-3 most common precipitating factors was trauma. Most common predisposing factors were advanced age, anemia, diabetes and alcoholism. Microbiological profile of patients reveals most polymicrobial organisms involved,most common organisms were streptococcus>E. coli,> staphylococci>pseudomonas/. Keywords: necrotizing, fasciitis, predisposing & management.

PREDISOPSING FACTORS; MANAGMENT AND OUTCOMES OF NECROTIZING FASCITIS Among patients who admitted to surgical ward at Al-Thawra hospital; January 2020 to January 2021: العوامل المسببة؛ إدارة ونتائج التفتت الناخر؛ لدى عينة من المرضى في قسم الجراحة بمستشفى الثورة بصنعاء

Background: Necrotizing fasciitis is a serious infection of skin and soft tissues that rapidly progresses along the deep fascia. It’s a fatal infection with high mortality if treatment delayed. Early diagnosis, surgical debridement and broad-spectrum antibiotic therapy are the optimal treatments to reduce the mortality. Objective: The aims were to identify risk factors for Necrotizing fasciitis and to describe the outcome of management. Methods: A prospective descriptive study was conduted at AL-THAWRA HOSIPTAL located in Sana’a, Yemen. All medical records of patients with confirmed NF who admitted to surgical department between January 2020 and January 2021 were reviewed. Results: The study enrolled 54 patients diagnosed with Necrotizing fasciitis. Male patients were 43 patients (79.6%) and female patients were 11 patients (20.3%). The age rang was 9 – 75 years old and the peak age incidence was at 46–60 years (33.3%). The incidence of NF increases with aging, male gander (79.6%), in comorbid patients (64.9%) especially DM (37%). The etiologies of NF were trauma in (16.6%) and perianal abscess in (14.8%), but (27.7%) of NF patients hadn’t specific cause. The defected wound was treated by skin graft in (32.5%) and primary closure in (27.5%). The mortality rate was (27.7% n=15); (60%) of them died on first 5 days. Septic shock was the reason of death in (73.2%). The higher mortality rate was seen at male gander (66.6%), age group > 60 years (46.6%), in patients who presented in shocked state (73.3%) and in comorbid patients (73.3%). Conclusion: Necrotizing fasciitis represents a life threatening condition with challenges in diagnosis. Incidence and mortality of NF are common in male gander, an elderly patient, or in who suffers of comorbidities; especially DM.

Fournier’s gangrene in females: A rare entity

Fournier’s gangrene is a form of necrotizing fascitis with abrupt onset of rapidly fulminating genital gangrene of idiopathic origin and gangrene up to deep fascia. It occurs usually in patients with urogenital infections and comorbidities such as diabetes, immunosuppression, or even trauma. Here, we present one such case of an 86-year-old female presenting with a history of pain and purulent discharge from the perianal region for 5 days. On examination, a wound of 20 × 15 cm perineal region extending up to the gluteal region posteriorly and labia majora anteriorly. The patient was planned for debridement under spinal anesthesia on an emergency basis followed by regular dressing and antibiotic therapy. The peri-operative period was uneventful. Along with surgical management, the patient was managed medically by control of sugars, treating sepsis with appropriate antibiotics. The patient recovered from sepsis, and the wound showed granulation tissue after 1 week of serial debridement. The wound was closed with a skin graft at a later date. Fournier’s gangrene should be kept as a differential diagnosis in females with perineal abscesses or necrotizing fascitis in females.

Patterns and diagnostic criteria of necrotizing fasciitis

Although the condition is not common, if the diagnosis of necrotizing fasciitis was established late, many life-threatening complications might develop as sepsis and septic shock, which might lead to multiorgan damage. In the present literature review, we aim to discuss the classification and clinical patterns of necrotizing fasciitis, in addition to the diagnostic criteria and modalities that were reported among studies in the literature to evaluate such cases. Two main types of necrotizing fascitis were reported in the literature, including the poly and monomicrobial types, however, the diagnostic criteria for each are usually similar. Establishing an early diagnosis is essential to achieve better management and reduce the potential development of complications and death. The clinical patterns are the cornerstone for establishing the diagnosis, however, laboratory investigations might also be used as valid approaches to confirm the diagnosis. Many laboratory models have been proposed to establish the diagnosis of necrotizing fasciitis with variable sensitivities and specificities, and the laboratory risk indicator for necrotizing fasciitis (LRINEC) remains the commonest most efficacious modality. A tissue biopsy can also be used within the clinical settings for indicating the infection, however, it should not hinder the intended surgical interventions. Studies also show that magnetic resonance imaging can adequately detect liquefactive necrosis and is reported with a higher sensitivity than computed tomography. Although the condition is not very common, it might lead to severe consequences, and therefore, early extensive treatment and interventional approaches are encouraged.

The clinical efficacy of laboratory risk indicator for necrotizing fascitis score in early diagnosis of patients with necrotizing fascitis

Background: Necrotizing fasciitis is a rare, rapidly progressive infection which causes extensive necrosis of the fascia and subcutaneous tissue. Early recognition and debridement are major prognostic determinants, and delay has been shown to increase mortality rate. We describe a novel, simple, and objective scoring system, the laboratory risk indicator for necrotizing fasciitis (LRINEC) score, based on routine laboratory investigations readily available at most centres, that can help to distinguish necrotizing fasciitis (nec fasc) from severe cellulitis or abscess.Methods: We performed a single centre, retrospective, all patients treated at the RLJ Hospital for necrotizing fasciitis between January 2017 and December 2019 were included in this study. The outcome of the study was based on comparing LRINEC score and Wang and Wong staging, which is useful to detect necrotizing fasciitis severity.Results: In our study, males were predominantly affected more common in lower limbs followed by perineum and abdominal wall in their fifties with diabetes mellitus and hypertension as dominant co-morbid diseases. In the study among subjects with high risk score, 83.3% required ICU stay, among subjects with moderate risk, 16.7% required ICU stay and among subjects with low risk, 12.5% required ICU stay.Conclusions: All patients with higher LRINEC scores and who were classified as ‘high risk’ in Wang and Wong classification required ICU stay and significant association with mortality rate.

Gangrena de Fournier. Reporte de caso

Fournier’s Gangrene is a type II necrotizing fascitis that leads to thrombosis of small subcutaneous vessels and spreads through the perianal and genital regions and the skin of the perineal. Most cases have a perianal or colorectal focus and in a smaller proportion it originates from the urogenital tract. The mortality rate varies between 7.8 and 50%1-3, only timely diagnosis decreases the morbidity and mortality of this condition. Treatment includes surgical debridement of all necrotic tissue and the use of broad-spectrum antibiotics. Key words: Fournier’s gangrene; gangrene; necrotizing fasciitis; infectious necrotizing of soft tissues.