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Article: A review of necrotising fasciitis in the extremities

TitleA review of necrotising fasciitis in the extremities
Authors
KeywordsClostridium
Epidemiology
Fasciitis, necrotizing
Streptococcus
Vibrio
Issue Date2009
PublisherHong Kong Medical Association. The Journal's web site is located at http://www.hkmj.org/resources/supp.html
Citation
Hong Kong Medical Journal, 2009, v. 15 n. 1, p. 44-52 How to Cite?
AbstractObjective: To review currently available evidence on the epidemiology and methods of management for necrotising fasciitis, with particular reference to Hong Kong. Data sources and study selection: Medline, PubMed, and Cochrane Library searches of local and internationally published English language journals, from 1990 to July 2008 using the terms 'necrotising fasciitis', 'Hong Kong', 'diagnosis', 'epidemiology', 'vibrio', 'streptococci', 'clostridia', and 'management'. Data extraction: All articles involving necrotising fasciitis in Hong Kong were included in the review. Data synthesis: The incidence of necrotising fasciitis in Hong Kong and around the world has been increasing. This rapidly progressive infection is a major cause of concern, due to its high morbidity and mortality. Up to 93% of affected patients at our hospital were admitted to the Intensive Care Unit and many still died from septic complications, such as pneumonia and multi-organ failure. Radical debridements in the form of amputations and disarticulations were considered vital in 46% of the patients. Early recognition and treatment remain the most important factors influencing survival. Yet, early diagnosis of the condition is difficult due to its similarities with many other soft tissue disorders such as cellulitis. Repeated surgical debridement or incisional drainage continues to be essential for the survival of sufferers from necrotising fasciitis. Many authorities have reported that carrying out the first fasciotomy and radical debridement within 24 hours of symptom onset was associated with significantly improved survival, which also emphasises the importance of early diagnosis. Conclusion: Clinicians must adopt a high index of suspicion for necrotising fasciitis. Empirical antibiotics must be started early and repeated physical examinations should be performed, while maintaining a low threshold for tissue biopsy and surgery. The timing of the first fasciotomy and radical debridement within a window of 24 hours from symptom onset is associated with significantly improved survival.
Persistent Identifierhttp://hdl.handle.net/10722/125209
ISSN
2015 Impact Factor: 0.887
2015 SCImago Journal Rankings: 0.279
References

 

DC FieldValueLanguage
dc.contributor.authorCheung, JPYen_HK
dc.contributor.authorFung, Ben_HK
dc.contributor.authorTang, WMen_HK
dc.contributor.authorIp, WYen_HK
dc.date.accessioned2010-10-31T11:17:37Z-
dc.date.available2010-10-31T11:17:37Z-
dc.date.issued2009en_HK
dc.identifier.citationHong Kong Medical Journal, 2009, v. 15 n. 1, p. 44-52en_HK
dc.identifier.issn1024-2708en_HK
dc.identifier.urihttp://hdl.handle.net/10722/125209-
dc.description.abstractObjective: To review currently available evidence on the epidemiology and methods of management for necrotising fasciitis, with particular reference to Hong Kong. Data sources and study selection: Medline, PubMed, and Cochrane Library searches of local and internationally published English language journals, from 1990 to July 2008 using the terms 'necrotising fasciitis', 'Hong Kong', 'diagnosis', 'epidemiology', 'vibrio', 'streptococci', 'clostridia', and 'management'. Data extraction: All articles involving necrotising fasciitis in Hong Kong were included in the review. Data synthesis: The incidence of necrotising fasciitis in Hong Kong and around the world has been increasing. This rapidly progressive infection is a major cause of concern, due to its high morbidity and mortality. Up to 93% of affected patients at our hospital were admitted to the Intensive Care Unit and many still died from septic complications, such as pneumonia and multi-organ failure. Radical debridements in the form of amputations and disarticulations were considered vital in 46% of the patients. Early recognition and treatment remain the most important factors influencing survival. Yet, early diagnosis of the condition is difficult due to its similarities with many other soft tissue disorders such as cellulitis. Repeated surgical debridement or incisional drainage continues to be essential for the survival of sufferers from necrotising fasciitis. Many authorities have reported that carrying out the first fasciotomy and radical debridement within 24 hours of symptom onset was associated with significantly improved survival, which also emphasises the importance of early diagnosis. Conclusion: Clinicians must adopt a high index of suspicion for necrotising fasciitis. Empirical antibiotics must be started early and repeated physical examinations should be performed, while maintaining a low threshold for tissue biopsy and surgery. The timing of the first fasciotomy and radical debridement within a window of 24 hours from symptom onset is associated with significantly improved survival.en_HK
dc.languageengen_HK
dc.publisherHong Kong Medical Association. The Journal's web site is located at http://www.hkmj.org/resources/supp.htmlen_HK
dc.relation.ispartofHong Kong Medical Journalen_HK
dc.rightsHong Kong Medical Journal. Copyright © Hong Kong Medical Association.-
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.subjectClostridiumen_HK
dc.subjectEpidemiologyen_HK
dc.subjectFasciitis, necrotizingen_HK
dc.subjectStreptococcusen_HK
dc.subjectVibrioen_HK
dc.subject.meshAeromonas - pathogenicity-
dc.subject.meshFasciitis, Necrotizing - complications - epidemiology - microbiology - therapy-
dc.subject.meshGram-Negative Bacterial Infections - complications - epidemiology - microbiology - therapy-
dc.subject.meshStreptococcal Infections - complications - epidemiology - microbiology - therapy-
dc.subject.meshStreptococcus pyogenes-
dc.titleA review of necrotising fasciitis in the extremitiesen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=1024-2708&volume=15&issue=1&spage=44&epage=52&date=2009&atitle=A+review+of+necrotising+fasciitis+in+the+extremities-
dc.identifier.emailCheung, JPY: jcheung98@hotmail.comen_HK
dc.identifier.emailIp, WY: wyip@hku.hken_HK
dc.identifier.authorityCheung, JPY=rp01685en_HK
dc.identifier.authorityIp, WY=rp00401en_HK
dc.description.naturepublished_or_final_version-
dc.identifier.pmid19197096-
dc.identifier.scopuseid_2-s2.0-61849150391en_HK
dc.identifier.hkuros178693en_HK
dc.identifier.hkuros212324-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-61849150391&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume15en_HK
dc.identifier.issue1en_HK
dc.identifier.spage44en_HK
dc.identifier.epage52en_HK
dc.publisher.placeHong Kongen_HK
dc.identifier.scopusauthoridCheung, JPY=24554121300en_HK
dc.identifier.scopusauthoridFung, B=7103203800en_HK
dc.identifier.scopusauthoridTang, WM=7403430820en_HK
dc.identifier.scopusauthoridIp, WY=35549641700en_HK

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