Necrotizing soft tissue infections: obstacles in diagnosis. J Am Coll Surg 1996 Jan;182(1):7-11
Date
01/01/1996Pubmed ID
8542094Scopus ID
2-s2.0-0030032892 (requires institutional sign-in at Scopus site) 148 CitationsAbstract
BACKGROUND: This study was done to identify obstacles in the early diagnosis and treatment of necrotizing soft tissue infections.
STUDY DESIGN: A ten-year retrospective case series was analyzed.
RESULTS: Data from 29 patients were analyzed. Among patients undergoing early operation within 24 hours of admission (n = 17) there was one death (6 percent mortality rate); survivors averaged 2.9 operations per patient. By comparison, of patients with delayed operation (n = 12) three died (25 percent mortality rate) and there were 3.6 operations per patients. Positive fine-needle aspiration (FNA) of suspicious lesions, demonstrating either pus or bacteria by Gram's stain, led to early operation in 80 percent of patients tested. Patients with soft tissue gas on radiographs were more likely to undergo early operation (58 percent). Delayed operation was more common in the absence of radiographic findings. All patients admitted to nonsurgical services had delayed operations.
CONCLUSIONS: Suspected necrotizing soft tissue infections require prompt surgical evaluation and early operative exploration. Early operation with definitive surgical therapy initiated within 24 hours of admission is associated with decreased mortality rates. Negative FNA findings, nondiagnostic radiographs, and admission to a nonsurgical service correlate with delay in definitive operative intervention.
Author List
Lille ST, Sato TT, Engrav LH, Foy H, Jurkovich GJAuthor
Thomas Sato MD Emeritus Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Biopsy, Needle
Fasciitis, Necrotizing
Female
Hospital Mortality
Humans
Male
Middle Aged
Retrospective Studies
Soft Tissue Infections
Time Factors
