6. Krieg:Umbruchvorlage 12.01.2009 9:39 Uhr Seite 32 32 EUROPEAN JOURNAL OF MEDICAL RESEARCH January 28, 2009 Table 2. Clinical and biochemical findings on admission in patients (n = 26) with necrotizing fasciitis. Clinical and Biochemical findings on admission No. of patients [%] Swelling Erythema Pain Skin necrosis Bullae formation Putride Secretion Crepitus Sensory/motor deficiencies Compartment syndrom Tachycardia Hypotension Leucocytosis Leucopenia 24 (92.3 %) 24 (92.3 %) 21 (80.8 %) 7 (26.9 %) 4 (15.4 %) 4 (15.4 %) 2 (7.7 %) 1 (3.8 %) 2 (7.7 %) 15 (57.7 %) 13 (50 %) 15 (57.7 %) 3 (11.5 %) and one patient (3.8 %) as ASA V according to the cri- teria of the American Society of Anaesthesiologists [18]. The majority of patients consequently presented in a critical condition of severe systemic disease, thus requiring catecholamine treatment because of hemo- dynamic instability in thirteen patients (50 %). The mean total white blood cell count was 13874/µl ± 8622.6 (range 2200 to 37260) and the mean C - reac- tive protein level was 26.9 mg/dl ± 13.5 (range 0.9 to 58.1). CT-scanning was performed in ten patients with necrotizing fasciitis (38.5 %), whereof diagnosis was correctly made in five cases (50 %) by two interpreting radiologists. A thickening of the fascial layer (90 %), edema of the adjacent muscle (80 %) and focal fluid collections (abscesses) (70 %) were detected more fre- quent in patients with necrotizing fasciitis (Fig. 2 A) than in CT scans performed for other soft tissue in- fections (70 %, 30 % and 40 %). Other CT morpho- logical observations such as a stranding of the subcu- taneous tissue (100 % in both groups) or soft tissue gas along fascial planes (50 % vs. 40 %) showed no obvious differences between both groups. CT scan therefore showed a sensitivity of only 50 %, a speci- ficity of 80 % and an accuracy of 71.4 %. There was no statistical significant correlation between CT-find- ings and other clinical or microbiological variables like type of infection or absence of anaerobes. In one pa- tient with type II disease a biopsy was necessary in or- der to establish the diagnosis (Fig. 2 B). Fig. 2. Morphological aspects of necrotizing fasciitis. Typical aspects on computed tomography (CT) scan included a thickening of the fascial layer, stranding of the subcutaneous tissue as well as edema of the adjacent muscle and local gas collections. (B) Histological hallmarks of necrotizing fasciitis with subcutaneous (a) and fascial (b) necrosis. (C) Intraoperative typical appear- ance of necrotic fascial layer and surrounding inflammatory tissue.