Necrotizing fasciitis: The role of early wide surgical  debridement and diversion colostomy

  • Najeeb S. Jabbo Department of surgery, Al_Mustansiriya Medical College, Baghdad, Iraq.
  • Haqqi I. Razzouki Department of surgery, Al- Yarmouk Teaching Hospital, Baghdad, Iraq
  • Sattar J. Kadhum Department of surgery, Al- Yarmouk Teaching Hospital, Baghdad, Iraq

Abstract

Background: Necrotizing fasciitis is a rare, progressive serious bacterial  infection of skin, subcutaneous tissue and fascia. It frequently affects the  perineum and genital areas in which local redness and edema progress  rapidly  to  necrosis  and  hemorrhagic  bullae.  Because  of  this  rapid  progression,  it  is  important  to  diagnose  and  treat  necrotizing  fasciitis  quickly.  Aims: To evaluate the role of early wide surgical debridement and diversion  colostomy in improving the prognosis. Methods: A case series study was done at Al‐ Yarmouk teaching hospital,  involving all patients diagnosed with NF and treated by the authors for a  three‐year period. Those patients were assessed clinically on admission and  followed  closely.  All  relevant  demographic,  clinical,  biochemical  and  radiological data were documented. The methods of treatment with special  emphasis on surgical debridement were recorded. The clinical outcome,  morbidity and mortality were recorded. Results:  Seventeen  cases  were  included,  11(64.7%)  male  and  6(35.3  %)  female. The mean age was 51+‐7 years and 64.7% were diabetics. The primary  sites affected were the perineum and scrotum, seen in 7 cases (41.1%). The  main presentation was excessive local pain, seen in 15cases (88.2%) and 15  patients had initial constitutional symptoms (88.2%). Blood cultures and  culture of debrided material revealed mainly group A streptococci and  proteus. Early wide debridement was done in 9 cases (52.9%) and those  patients had earlier healing and shorter stay in hospital (mean stay 20 days).  Initial local debridement was done in 6cases (35.2%) and the mean duration  of stay in hospital was 40 days. Diversion colostomy was done for 3 patients  (29.4%) and all had early healing without mortality. There were 3 deaths  (17.7%), two of them had initial local debridement. Conclusions: Early wide surgical debridement is essential and improves  healing,  shortens  hospital  stay  and  decreases  mortality.  Diversion  colostomy is helpful in some cases but needs further evaluation. 

Published
2018-06-09
How to Cite
JABBO, Najeeb S.; RAZZOUKI, Haqqi I.; KADHUM, Sattar J.. Necrotizing fasciitis: The role of early wide surgical  debridement and diversion colostomy. Mustansiriya Medical Journal, [S.l.], v. 13, n. 2, p. 6, june 2018. ISSN 2227-4081. Available at: <http://mmj.uomustansiriyah.edu.iq/index.php/MMJ/article/view/210>. Date accessed: 10 apr. 2020.