EXPERIENCE WITH REGIONAL NECROTIZING FASCIITIS

Abstract

Objective: To identify the systemic predisposing factors, in patients ........ Regional

local etiological factors and to assess the role of aggressive debriedement as a part of treatment.

Material and Methods: This prospective study was conducted at the surgical departments of Khyber

Teaching Hospital, Lady Reading Hospital and Hayatabad Medical Complex Peshawar Pakistan from 1st

January 2002 to 30th Jun 2007. Total number of patients was 60. Both male and female were included.

Detail history and examination of all patients was carried out. After initial resuscitation all patients were

treated aggressively including surgical debridement.

Results: Total number of patients studied was 60. Male to female ratio was 5:1. Age ranged 25-75 with

mean 48.2+18.5(SD) years. Extent of the disease was to scrotum in 30%(n=18), to perineum in

50%(n=30), to abdominal wall in 20%(n=12).Systemic predisposing factors identified in our study was

Diabetes Mellitus in 30%(n=18), Chronic alcohol abuse in 7% (n=4), long standing steroid therapy in

7%(n=) while in 56%(n=34) patients no cause could be ascertained. The local etiological origin of

Fournier's gangrene was urogenital in 24.33% (n=14), anorectal in16.67%(n=10), cutaneous in

13.33%(n=8) of patients where as in 46.67%(n=28) no local pathologies could be identified. . The mean

time interval between first symptom and initial treatment was 2.5 days with a rang 1-7 days. Debridement

sessions ranged 2-5(mean3.14). Mean hospital stay was 30+7 days with range 10-50 days. Mortality was

6.67% (n=4).

Conclusion: Necrotizing Fasciitis can occur in perfectly healthy population. Local etiological

pathologies in the form of urogenital, anorectal, and cutaneous may trigger this dreadful disease in some

patients. Early recognition and aggressive surgical debridment are the main stay of treatment.