A review of necrotizing fasciitis in the extremities

Abstract

Objective: To review currently available evidence on the epidemiology and management methods of necrotizing fasciitis in particular reference to Hong Kong. Data Sources and study selection: MEDLINE, Pubmed and Cochrane Library searches of local and internationally published English journals between years 1990 to 2008 regarding necrotizing fasciitis. Data extraction: All articles involving necrotizing fasciitis in Hong Kong were included in the review. Discussion: The incidence of necrotizing fasciitis in Hong Kong and around the world is on an increasing trend. Hong Kong being a coastal city is a major risk factor shown by the high prevalence of positive vibrio culture growths in 83.3% of cases. This rapidly progressive infection is a major cause of concern due to its high rates of morbidity and mortality. Up to 93% of patients with this condition are admitted to the Intensive Care Unit and many patients still die by septic complications. Early recognition and treatment of necrotizing fasciitis is important but is difficult because of its similarities with other soft tissue disorders like cellulitis. Repeated surgical debridement or incisional drainage remains essential to survival. Radical debridements in the form of amputations and disarticulations are vital in 45.8% of patients. Many articles report that the timing of first fasciotomy and radical debridement within a window period of 24 hours from symptom onset is associated with significant improvement in survival. Clinicians must have a high index of suspicion for necrotizing fasciitis and maintain a low threshold for tissue biopsy and surgery.