Clinicopathology study of necrotizing fasciitis with special reference to Fournier’s gangrene
DOI:
https://doi.org/10.18203/2349-2902.isj20174523Keywords:
Fournier’s gangrene, Necrotizing fasciitisAbstract
Background: Necrotizing fasciitis including Fournier’s gangrene is an uncommon, critically serious infection of the subcutaneous tissue and fascia with relative sparing of the skin and muscle. Despite modern supportive measures, the reported mortality rate still is high and this is due to part to the aggressive nature of the infection. The present study was performed upon 50 patients to study clinicopathology of necrotizing fasciitis with special reference to Fournier’s gangrene.
Methods: This cross-sectional study was conducted in Surgery ward of SGRD Hospital, for a period of 1 year (1st January 2015 to 31st December 2015). The performa filled for patients with necrotizing fasciitis was designed on the basis of NICE guidelines and details like history, examination, general survey, local examination, systemic examination and investigations, statistical analysis of data done.
Results: Necrotizing fasciitis, though it is found at any age but is a disease of middle and old aged adults in this part of the world, being commonest in the 4th, 5th, 6th decades of life and is more common in males. The disease is more common in people with low socio-economic groups with poor personal hygiene, diabetes mellitus and history of drug addiction. Trauma is the most common predisposing factor for the necrotizing fasciitis as a whole whereas idiopathic cause is the most common cause in cases of Fournier’s gangrene. Polymicrobial infection is the most common variety, where in E. coli, Streptococcus, Bacteroids are most commonly isolated. Regarding monobacterial infection streptococcus being the most common.
Conclusion: Current study showed increased frequency of necrotizing fasciitis in people aged above 40 years. Diabetes mellitus and other premorbid conditions increase the risk of mortality. Polymicrobial infection in combination of Escherichia coli, Streptococcus, Pseudomonas, Bacteroids and Staphylococcus were the most commonly found. Early debridement, parenteral combined antibiotic and supportive measure formed the basis of treatment. Septicemia was a common complication which was often cause death.
References
Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Pollock RE. Schwartz’s principle of surgery. 8th ed. McGraw-Hill Companies; Chapter 5: Surgical Infections: Gregory J. Beilman and David L. Dunn; 2005:78-96.
Jones RB, Hirschmann JV, Brown GS, Tremann JA. Fournier's syndrome: necrotizing subcutaneous infection of the male genitalia. J Urol. 1979;122(3):279-82.
Majeski J, Majeski E. Necrotizing fasciitis: Improved survival with early recognition by tissue biopsy and aggressive surgical treatment. South Med J. 1997;90:1065-8.
Laor E, Palmer LS, Tolia BM, Reid RE, Winter HI. Outcome prediction in patients with Fournier's gangrene. J Urol. 1995;154:89-92.
Green RJ, Dafoe DC, Raffin TA. Necrotizing fasciitis. Chest. 1996;110:219-29.
Descamps V, Aitken J, Lee MG. Hippocrates on necrotising fasciitis. Lancet. 1994;344:556.
Fournier JA. Gangrene. Lightning Strike. Med Week. 1883;3:345-8.
Faucher LD, Morris SE, Edelman LS, Saffle JR. Burn center management of necrotizing soft-tissue surgical infections in unburned patients. Am J Surg. 2001;182:563-9.
Chapnick EK, Abter EI. Necrotizing soft-tissue infections. Infect Dis Clin North Am. 1996;10(4):835-43.
Beltran J. MR Imaging of soft tissue infection. Magn Reson Imaging. Clin N Am. 1995;3:743-51.
Bosshardt TI, Henderson VJ, Organ CH. Necrotizing soft-tissue infections. Arch Surg. 1996;131:846-54.
McHenry CR, Piotrowski JJ, Teprinic D, Malangoni MA. Determinants of mortality for necrotizing soft-tissue infections. Ann Surg. 1995;221:558-65.
Lille St, Sato TT, Engrav LH, Foy H, Jurkovich GJ. Necrotizing soft tissue infections: Obstacles in diagnosis. J Am Coll Surg. 1996;182:7-11.
Elliott DC, Kufera JA, Myers RAM. Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Ann Surg. 1996;224:672-83.
Majeski JA, Alexander JW. Early diagnosis, nutritional support, and immediate extensive debridement improve survival in necrotizing fasciitis. Am J Surg. 1983;145:784-7.
Sudarsky LA, Laschinger JC, Coppa GF, Spencer FC. Improved results from a standardized approach in treating patients with necrotizing fasciitis. Ann Surg. 1987;206:661-5.
Rubinstien E, Dehertogh D, Brettman L. Severe necrotizing soft tissue infections: Report of 22 cases. Conn Med. 1995;59:67-72.
Endorf FE, Supple KG, Gamelli RL. The evolving characteristics and care of necrotizing soft-tissue infections. Burns. 2005;31:269-73.
Kuncir EJ, Tillou A, St Hill CR. Necrotizing soft-tissue infections. Emerg Med Clin North Am. 2003;21:1075-7.
Stone DR, Gorbach SL. Necrotizing fasciitis: the changing spectrum. Dermatol Clin. 1997;5(2):213-20.
Eke N. Fournier's gangrene: a review of 1726 cases. BJS. 2000;87(6):718-28.
Smith GL, Bunker CB, Dinneen MD. Fournier's gangrene. BJU. 1998;81(3):347-55.
Miller CW, Prescott JF, Mathews KA, Betschel SD, Yager JA, Guru V, et al. Streptococcal toxic shock syndrome in dogs. J Am Vet Medi Assoc. 1996;209(8):1421-6.
Weinbren, MJ and Perinpanayagam, RM. Streptococcal necrotising fasciitis. J Infect. 1992;25:299-302.
Clayton MD, Fowler JE, Sharifi R, Pearl RK. Causes, presentation and survival of fifty-seven patients with necrotizing fasciitis of the male genitalia. Surg Gynecol Obstet. 1990;170:49-55.
