Necrotizing Fasciitis: our experience in the Second Chair of Surgery

Abstract

Introduction: Necrotizing Fasciitis is a soft tisúes infection, caused by the synergic action of aerobic and anaerobic microorganisms; its evolution is potentially lethal.

Objective: Revision of data on the origin of this disease, the concomitants affections, the treatment and the results.

Patients y methods: Observacional study, descriptive, retrospective of 35 patients treated in the Second Chair of Surgery, FCM-UNA, in the period between March 95 and February 05. The antibiotic therapy implemented was cefotaxim (4grams/day) or ciprofloxacin (800 grams/day), associated to metronidazol (1.5 grams/day) The surgical treatment consisted in extensive incisions in several opportunities.

Results: 26 male and 9 women. The average age was of 51.5 years (18-85). The location was: 21 patients in the perineal region, 6 in the inferior right member, 5 inferior left member and 3 in the abdominal wall. The initial infectious focus was: anal abscess in 13 patients, skin abscess 8 patients, urological affections 7, ofidic accidents 3, trauma 3 and piodermitis 1 patient.

The disease most frequently associated was the diabetes mellitus (25 patients), others were: ischemic cardiopathy (13 patients), TBC (2 patients), Rheumatoid Arthritis (1 patient) and Alcoholism (1 patient).

In the cultures were isolated: Escherichia Coli in 15 patients, Acinetobacter in 8 patients, Streptococo Piógenes in 8 patients, Klebsiella in 5 patients, Enterococo in 5 patients and in 1 patient Proteus Vulgaris and Citrobacter Freudii; in all the cases accompanied by anaerobic: Clostridium and Bacteroides.

The complementary surgical gestures were: cistostomy in 2 patients and diversion colostomies in 10 patients. The time of hospitalization had an average of 45 days (4-201).

Twelve patients entered to intensive care units, 5 of them were diagnosed septic shock and passed away.

The evolution of the wound was satisfactory, most of them cured by second intention, in 5 patients were made skin and muscle flap, and in 6 patients, grafts, all successfully.

Conclusion: With evolution may be lethal and it appearance is a frequent in the general surgery services.

• The treatment must be quick and aggressivewith large dissections, and the antibioticoterapy and the most common associated disease was Diabetes Mellitus. -The Gram negative and anaerobic germs were isolated in all patients. -Mortality was of 14.2%