A Five-year Retrospective Research Of Necrotizing Fasciitis In The Extremities: Clinical Characteristics And Therapeutic Regimen

Objectives:To describe the clinical characteristics and outcomes of necrotizing fasciitis in the extremities.Methods:There were 33 patients admitted necrotizing fasciitis of limbs in the First Bethune Hospital of Jilin University from January 2003 to December 2018.Demographic data,clinical features,site of infection,predisposing factors,duration of symptoms,microbiology,laboratory examination,LRINEC score,SIARA score,number of surgical interventions,anti-infection treatments,in-hospital complications and outcomes were retrospectively investigated.Results:Among 33 cases,the most common predisposing factors were wound infection(4 cases)and diabetic foot ulcer(4 cases).The most common clinical presentation was swelling(32 cases)and pain(23 cases).The positive predictive value of LRINEC score was 66.7%,and the positive predictive value of SIARI score was 63.6%.30 cases underwent their first debridement within 12 h of admission(mean 7.3h).27 cases underwent more than 2 surgical interventions including debridement,with an average of 2.9(range 2-6).The mean length of stay was 37.4 days(range 5-61).The most common complications during hospitalization were deep venous thrombosis of the lower extremity(13 cases)and whole lung pneumonia(9 cases).4 cases died and 4cases underwent limb amputations.Discussion:Necrotizing fasciitis is insidious and rapidly progressing with a high mortality.Early detection and aggressive debridement are vital of NF treatment.Finger test can be used as an effective diagnostic method.Surgical intervention should pay more attention to decrease physical and psychological trauma caused by skin defects.