Necrotizing Fasciitis of the Upper and Lower Limbs: Port Harcourt Experience
ABSTRACT
Background: Necrotizing fasciitis (NF) is a rare but life-threatening soft-tissue infection characterized by rapidly spreading inflammation and subsequent necrosis of the fascial planes and surrounding tissue. Aim: To determine the clinical characteristics at presentation, causative pathogens and clinical outcome of NF after aggressive management. Patients and methods: We retrospectively reviewed case notes of patients with NF referred to the Teaching Hospital in Port Harcourt from January 2004 to December 2009. Results: The case notes of over 2,280 patients with history of cellulitis and/or infections of the upper and lower limbs were reviewed. These cases were seen in a five-year period from 2004 to 2009. Seventy five (3.29%) patients had a diagnosis of necrotizing fasciitis and were evaluated. Only those with infections on the lower and upper limbs were further analyzed. Thirty five (46.67%) patients had their infections in the lower limb while 40 (53.33%) patients had their infections in the upper limb. Twenty (26.67%) patients were found to be diabetic on admission. Thirty (30%) patients sustained injuries on their limbs while 5 (6.67%) patients could not give account of their infections. Eleven (14.66%) patients had fixed flexion deformities as their wounds healed and had to have further plastic surgery to extend their limbs and 7 (9.33%) patients died while on admission. Conclusion: Although an early diagnosis of NF can be difficult, a high index of suspicion is required in all patients presenting with unexplained warmth and/or cellulitis of the limbs, so that prompt and aggressive debridement can be carried out with commencement of broad spectrum antibiotics.
Background: Necrotizing fasciitis (NF) is a rare but life-threatening soft-tissue infection characterized by rapidly spreading inflammation and subsequent necrosis of the fascial planes and surrounding tissue. Aim: To determine the clinical characteristics at presentation, causative pathogens and clinical outcome of NF after aggressive management. Patients and methods: We retrospectively reviewed case notes of patients with NF referred to the Teaching Hospital in Port Harcourt from January 2004 to December 2009. Results: The case notes of over 2,280 patients with history of cellulitis and/or infections of the upper and lower limbs were reviewed. These cases were seen in a five-year period from 2004 to 2009. Seventy five (3.29%) patients had a diagnosis of necrotizing fasciitis and were evaluated. Only those with infections on the lower and upper limbs were further analyzed. Thirty five (46.67%) patients had their infections in the lower limb while 40 (53.33%) patients had their infections in the upper limb. Twenty (26.67%) patients were found to be diabetic on admission. Thirty (30%) patients sustained injuries on their limbs while 5 (6.67%) patients could not give account of their infections. Eleven (14.66%) patients had fixed flexion deformities as their wounds healed and had to have further plastic surgery to extend their limbs and 7 (9.33%) patients died while on admission. Conclusion: Although an early diagnosis of NF can be difficult, a high index of suspicion is required in all patients presenting with unexplained warmth and/or cellulitis of the limbs, so that prompt and aggressive debridement can be carried out with commencement of broad spectrum antibiotics.
Cite this paper
nullR. Jamabo and S. Elenwo, "Necrotizing Fasciitis of the Upper and Lower Limbs: Port Harcourt Experience," International Journal of Clinical Medicine, Vol. 2 No. 2, 2011, pp. 86-88. doi: 10.4236/ijcm.2011.22017.
nullR. Jamabo and S. Elenwo, "Necrotizing Fasciitis of the Upper and Lower Limbs: Port Harcourt Experience," International Journal of Clinical Medicine, Vol. 2 No. 2, 2011, pp. 86-88. doi: 10.4236/ijcm.2011.22017.
References
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[1] [1] D. Huljev and N. Kucisec-Tepes, “Necrotizing Fasciitis of the Abdominal Wall as a Post-Surgical Complication: A Case Report,” Wounds, Vol. 17, No. 7, 2005, pp. 169-177. [2] [2] J. N. Legbo and J. F. Legbo, “Bacterial Isolates From Ne- crotizing Fasciitis: A Clinico-Pathological Perspective,” Nigerian Journal of Medicine, Vol. 16, No. 2, 2007, pp. 143-147. [3] [3] R. J. Green, D. C. Dafoe and T. A. Raffin, “Necrotizing Fasciitis,” Chest, Vol. 110, No. 1, 1996, pp. 219-229. doi:10.1378/chest.110.1.219 [4] [4] R. Puvanendran, J. C. Huey and S. Pasupathy, “Ne- crotizing Fasciitis,” Canadian Family Physician, Vol. 55, No. 10, 2009, pp. 981-987. [5] [5] E. J. Whallett, J. H. Stevenson and A. D. Wilmshurst, “Necrotizing Fasciitis of the Extremity,” Journal of Plastic, Reconstructive & Aesthetic Surger, Vol. 63, No. 5, 2010, pp. 469-473. doi:10.1016/j.bjps.2009.09.011 [6] [6] S. D. Fritzsche, “Soft Tissue Infection: Necrotizing Fa- sciitis,” Plastic Surgery Nursing, Vol. 23, No. 4, 2003, pp. 155-159. [7] [7] M. Nisbet, G. Ansell, S. Lang, S. Taylor, P. Dzen- drowskyj and D. Holland, “Necrotizing Fasciitis: Review of 82 Cases in South Auckland,” Journal of Clinical Endocrinology & Metabolism, Vol. 95, No. 1, 2010, pp. 11-12. [8] [8] A. Rajput, Waseem, A. Samad, T. W. Khanazada, G. M. Shaikh and G. A. Channa, “Mortality in Necrotizing Fasciitis,” Journal of Ayub Medical College Abbottabad, Vol. 20, No. 2, 2008, pp. 96-98. [9] [9] C. H. Wong and Y. S. Wang, “The Diagnosis of Necrotizing Fasciitis,” Current Opinion in Infectious Diseases, Vol. 18, No. 2, 2005, pp. 101-106. doi:10.1097/01.qco.0000160896.74492.ea [10] [10] E. J. McGee, “Necrotizing Fasciitis: Review of Patho- physiology, Diagnosis and Treatment,” Critical Care Nursing Quarterly, Vol. 28, No. 1, 2005, pp. 80-84.