A 5-year retrospective analysis of Necrotizing fasciitis: A single center experiences
Authors: Kiralj Aleksandar , Janjic Zlata , Nikolic Jelena , Markov Borislav , Marinkovic Marija 
Published: December 2014

Background/Aim. Necrotizing fasciitis (NF) is usually an acute infection of
superficial fascia with rapid progression in around soft tissue. If not
promptly recognized and aggressively treated NF usualy leads to sepsis and
multiorgan failure with fatal outcome, thus early diagnosis and prompt
surgical treatment are crucial for healing of these patients. The aim of this
article was to evaluate the clinical presentation of all patients with acute
NF diagnosed and treated in surgical clinics of Clinical Center of Vojvodina,
Novi Sad, Serbia. Methods. The medical records of patients treated for acute
NF localized on a different parts of the body in Clinical Center of
Vojvodina, Novi Sad, Serbia, during a 5- year period (from January 2008 to
December 2012) were retrospectively evaluated. This study enrolled patients
admitted via Emergency Center of Vojvodina with the diagnosis of acute NF
either as the primary diagnosis or with the diagnosis at discharge after
surgical treatment. Results. During a 5-year period there were 216 patients
with final diagnosis of acute NF. Most of our patients (140 - 64.81%) were
admitted with the initial diagnosis of cellulitis, abscesses, phlegmons or
sepsis. Unfortunately, the clinical symptoms of acute NF were atypical at
time of initial examination. Pain and swelling of the affected localization
were the most presented bias of symptoms (183 - 84.72%). The majority of our
patients were male (164 - 75.92%). Among the 216 patients, the most common
pre-existing single factor was drug abuse (39 - 18.05%), followed by obesity
(38 - 17.59%) and diabetes mellitus (31 - 14.35%). Trauma was most common
etiological factor (22 - 10.8%) in infected wounds, followed by abdominal (15
- 6.94%) and orthopedic (11 - 5.09%) surgical intervention. In the present
study idiopathic acute NF was diagnosed in 22 (10.18%) patients and more than
one etiological factor were diagnosed in 20 (9.25%) patients. The majority of
our patients had type I acute NF (172 - 79.62%) with Streptococcal species as
the most common microorganism (125 - 71.02%). The most common localization
was an extremity (151 - 69.90%). The minority of our patients had head and
neck localization of infection (7 - 3.24%). Surgical treatment was performed
in all the patients and most of them (183 - 84.72%) received the first
surgery within 24 h. Other patients (23 - 10.64%) received operation after
stabilization of general status or after getting the diagnosis of acute NF
(unclear diagnosis on admission). During hospitalization, the most common
complication among our patients was sepsis (156 - 72.22%). The mortality rate
was 14.35%. Conclusion. Acute NF is a rare but very difficult and sometimes
life-threatening disease of superficial fascia and around soft tissue. If
acute NF is suspected, early radical excision of all the affected tissue with
exploration and excision of superficial fascia with pathological and
microbiological assessment are most significant for treatment. Appropriate
antibiotics and intensive care setting to manage other organ failure of NF
are recommended at the same time with surgery.