Necrotizing fasciitis; diagnostic parameters for early detection and subsequent improved surgical outcome

Aim of the work: To identify the pattern of clinical manifestation and surgical outcome in relation to timing of presentation and surgical interference. Patients and methods: This prospective study was carried out in Surgery Department, Sohag University Hospital from July 2010 to April 2014. Necrotizing fasciitis (NF) was diagnosed clinically and confirmed by intraoperative findings and routine postoperative histopathological study. Clinical criteria in association to laboratory values e.g. total leucocytic count; band leucocytes percentage and serum Na were recorded. According to these criteria, patients were classified into 2 groups: group A; 26 patients with objective criteria of NF and group B; 136 patients with criteria of non-NF (control group). Results: There were a statistically significant differences between NF and non NF patients with respect to pain, tense edema, bullae, skin discoloration and crepitation (P= 0.04, 0.01, 0.032, 0.023, and 0.045 respectively). Elevated WBCs >15.4 ×109 /L was found in 69% of group A patients and 8% of group B (p=0.0001). Band form leucocytes percentage >10% was observed in 23.08 % of group A and 6.61% of group B (p=0.0001). Serum Na<135 mm/L was observed in 85% and10% of group A and B respectively ((p=0.0001). Repeated wide surgical debridement was done to 22 patients of group A and the remaining 4 cases were subjected to major extremity amputations. The overall mortality was 27% (7 patients) for group A (NF group) versus zero% for group B (non-NF group) (p<0.0001). Among patients underlying early debridement within 12 hours of admission (n=17), there was 3 deaths (18%) versus 4 deaths out of 9 (44.4 %) were recorded in patients with delayed operation (P< 0.05). Conclusion: NF is a potentially fatal disease. Early diagnosis remains the cornerstone in achieving reasonable surgical outcome. In patients with clinical suspicious, laboratory parameters include WBCs >15.4×109/L , serum Na < 135 mmol/L and band form leucocytes percentage > 10% may be helpful in early diagnosis.