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