Necrotizing fasciitis.

Fourteen patients with necrotizing fasciitis seen over a 5 year period at a public hospital are reviewed. Middleaged men predominated. The disease followed such diverse initiating causes as self-injection with heroin, boil, ischiorectal abscess, perforated occult colonic cancer and trivial abrasions. In a few cases there was no evidence of an initiating lesion. Necrotizing fasciitis affected the arms, legs, trunk and neck. Bacteriologic analysis showed that the disease is usually caused by gram-negative bacilli and hemolytic streptococci, alone or in combination. Morbidity and mortality rates in the present series were influenced by associated clinical conditions such as old age, diabetes mellitus, carcinoma and gram-negative bacteremia.