Acute necrotizing fasciitis in Egyptian patients: a case series.

Hyperacute soft tissue infection is an uncommon infectious entity, which mostly affects immunocompromised individuals, mainly diabetics and poses difficult diagnostic and therapeutic management decisions. This study addresses the presentation, evaluation and management of 37 diabetic patients with acute necrotizing fasciitis treated throughout the period between August 1993 and July 2006 by the main author. Extremities, trunk and perineum were the most commonly involved sites with an incidence of 35%, 30% and 27%, respectively. All patients presented with cellulitis, which was associated with oedema in 75.6% of cases, skin gangrene in 59% of cases and brown ecchymotic patches in 30% of cases. Skin vesicles, tenderness and crepitations were present in 13.5%, 11% and 11% of cases, respectively. Streptococci, Staphylococci and E coli were the most commonly encountered organisms, which affected 70% of cases, either alone or in combination. Anaemia and hypoalbuminaemia were the most commonly encountered laboratory findings in 75.6% and 84% of cases, respectively. The mortality rate in the 37 patients included in this study was 43% (16 cases); in 11 of them the infection was located in the trunk and perineum. Once necrotizing fasciitis is suspected, exploration of the fascia is mandatory with pathological assessment of tissue specimens. Radical debridement of the affected area, maintenance of adequate nutritional support and systemic antibiotic therapy should be implemented at once in order to reduce mortality and insure safe recovery of patients.