Factors affecting the mortality of necrotizing fasciitis involving the upper extremities

Necrotizing fasciitis involving the upper extremities is an uncommon, but potentially life-threatening infection. Surgical records were reviewed to identify its mortality risk factors. A 10-year retrospective review was conducted of all patients with upper limb necrotizing fasciitis treated in a tertiary care hospital in northern Taiwan. The demographic data, physical and laboratory findings and salient information with respect to the treatment and clinical outcome were collected and analyzed. Fourteen patients were identified. The mean age of the all-male cohort was 60.2 years (range, 44-83 years). Five of the patients died, yielding a mortality rate of 35.7%. At the time of presentation, all 14 patients had pain and swelling, but fever occurred in only 7 patients. Associated chronic debilitating diseases, of which diabetes mellitus was the most common, were present in 9 individuals. Patients underwent an average of two surgical debridements. The initial presentation in a state of altered consciousness or respiratory distress was found to be a statistically significant factors for eventual mortality (P < 0.05). The results showed that necrotizing fasciitis of the upper extremity is associated with a high mortality rate. Early diagnosis and referral for aggressive surgical treatment before the development of systemic toxic signs are therefore considered to be essential for survival.