NECROTISING FASCIITIS: A CLINICOPATHOLOGICAL STUDY

BACKGROUND Necrotising Fasciitis (NF) is a necrotising soft tissue infection involving the fascia and subcutaneous tissue. It can cause rapid local tissue necrosis and life-threatening severe sepsis that needs prompt recognition, extensive debridement, immediate antibiotic therapy and intensive care treatment. The aim of this study was to investigate the aetiopathogenesis, demographics, different sites of involvement, investigations and management of necrotising fasciitis. METHODS AND MATERIALS The study was undertaken from July 2015 to June 2016 for a period of one year, patients who were admitted to surgical department at Bangalore Medical College and Research Institute formed the study. RESULTS 50 patients of necrotising fasciitis were treated during the study period. The age group ranged from 21- 90 years. There were 39 males and 11 females. The lower extremity was the most common site involved in 28 (56%) patients followed by the perineum in 12 (24%) patients and upper extremity in 5(10%) patients. We witnessed one case of necrotising infection of the breast. No predisposing factor was present in 27(54%) patients. Trivial trauma was the most common predisposing factor found in 18 (36%) patients. Regarding clinical features, local erythema and swelling were present in 38 (76%) patients, pain was present in 31 (62%) patients, bullous lesion was present in 15 (30%) patients. The commonest organism involved was E. coli in 13 (26%) patients followed by Klebsiella found in 9 (18%) patients. Accurate assessment and timely intervention are critical in the treatment of patients affected with NF. Understanding the history and unique characteristics of this disease is crucial to achieve early recognition, effective treatment and a favourable outcome. CONCLUSION Necrotising fasciitis is a life threatening infection of the fascia and subcutaneous tissue. The presentation of the disease is nonspecific and variable. High index of suspicion and knowledge is essential for early diagnosis of NF. Delay in recognition and effective treatment increases the mortality. Radical surgical debridement, broad spectrum antibiotics, negative pressure wound dressings, and hyperbaric oxygen therapy are considered to be the cornerstone of treatment.