Aggressive surgical management of necrotizing fasciitis serves to decrease mortality: a retrospective study
Necrotizing fasciitis is an aggressive soft-tissue infection that in the past has carried a significant mortality rate. One of the most important determinants of outcome is recognition of the disease process. This is followed by aggressive resuscitation measures and radical debridement at the initia...
Saved in:
Published in | The American surgeon Vol. 64; no. 5; pp. 397 - 400; discussion 400-1 |
---|---|
Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
01.05.1998
|
Subjects | |
Online Access | Get full text |
Cover
Loading…
Abstract | Necrotizing fasciitis is an aggressive soft-tissue infection that in the past has carried a significant mortality rate. One of the most important determinants of outcome is recognition of the disease process. This is followed by aggressive resuscitation measures and radical debridement at the initial operation to control the infectious spread at the outset. The objective of this study is to help reveal the benefits of aggressive early surgical debridement in the treatment of necrotizing fasciitis. A retrospective review of the medical records of 68 patients between the years 1980 and 1996 with the diagnosis of necrotizing fasciitis was performed. The patients were assigned to two groups, Group A (21; 31%), who had delay in therapy or inadequate preliminary therapy and Group B (47; 69%), who underwent aggressive surgical debridement from the outset. Concomitant disease processes were noted. The medical records of 68 patients were studied. Age ranged from 13 to 67 (mean, 52) years of age. There were 38 (56%) females, 21 (64%) of the patients were African-American, 24 (73%) of the patients had concomitant disease processes, 29 (42%) of the patients had a history of tobacco use, 11 (16%) of the patients had a history of alcohol consumption, and 11 (16%) of the patients were obese. Mortality in Group A was 8 of 21 patients (38%). Mortality in Group B was 2 of 47 patients (4.2%). The difference in mortality was found to be statistically significant (P = 0.0007). Early recognition and expeditious initial wide excision and debridement along with appropriate antibiotic coverage and support of systemic effects of necrotizing fasciitis serve to decrease morbidity and mortality. We believe the above is an absolute necessity followed by frequent washing and minor debridement of the wound until granulating tissue is observed. This can then be followed by procedures to close/cover the surgical defect (i.e., split-thickness skin grafts or various coverage flaps). |
---|---|
AbstractList | Necrotizing fasciitis is an aggressive soft-tissue infection that in the past has carried a significant mortality rate. One of the most important determinants of outcome is recognition of the disease process. This is followed by aggressive resuscitation measures and radical debridement at the initial operation to control the infectious spread at the outset. The objective of this study is to help reveal the benefits of aggressive early surgical debridement in the treatment of necrotizing fasciitis. A retrospective review of the medical records of 68 patients between the years 1980 and 1996 with the diagnosis of necrotizing fasciitis was performed. The patients were assigned to two groups, Group A (21; 31%), who had delay in therapy or inadequate preliminary therapy and Group B (47; 69%), who underwent aggressive surgical debridement from the outset. Concomitant disease processes were noted. The medical records of 68 patients were studied. Age ranged from 13 to 67 (mean, 52) years of age. There were 38 (56%) females, 21 (64%) of the patients were African-American, 24 (73%) of the patients had concomitant disease processes, 29 (42%) of the patients had a history of tobacco use, 11 (16%) of the patients had a history of alcohol consumption, and 11 (16%) of the patients were obese. Mortality in Group A was 8 of 21 patients (38%). Mortality in Group B was 2 of 47 patients (4.2%). The difference in mortality was found to be statistically significant (P = 0.0007). Early recognition and expeditious initial wide excision and debridement along with appropriate antibiotic coverage and support of systemic effects of necrotizing fasciitis serve to decrease morbidity and mortality. We believe the above is an absolute necessity followed by frequent washing and minor debridement of the wound until granulating tissue is observed. This can then be followed by procedures to close/cover the surgical defect (i.e., split-thickness skin grafts or various coverage flaps). |
Author | Zibari, G B Aultman, D F McDonald, J C Bilton, B D Dunn, G McMillan, R W |
Author_xml | – sequence: 1 givenname: B D surname: Bilton fullname: Bilton, B D organization: Department of Surgery, Louisiana State University Medical School- Shreveport, USA – sequence: 2 givenname: G B surname: Zibari fullname: Zibari, G B – sequence: 3 givenname: R W surname: McMillan fullname: McMillan, R W – sequence: 4 givenname: D F surname: Aultman fullname: Aultman, D F – sequence: 5 givenname: G surname: Dunn fullname: Dunn, G – sequence: 6 givenname: J C surname: McDonald fullname: McDonald, J C |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/9585771$$D View this record in MEDLINE/PubMed |
BookMark | eNotkD9PwzAUxD0UlbbwEZA8sUWy47p22KqKf1IlFpijl_glMiRx8HMqlU9PBJ1Od_fTDbdmiyEMuGArIYTKpNraa7Ym-pztdqflki0LbbUxcsW-9m0bkcifkNMUW19Dx3sYoMUeh8RDwwesY0j-xw8tb4Bq75MnThhPSDwF7uYegZD3ISbofDo_cOARUww0Yp3-ptPkzjfsqoGO8PaiG_bx9Ph-eMmOb8-vh_0xG3OxS1nurFPOVgaMrsFZoVFALmXdoK2EcLlwSuZa6BwMQqFnSlZzhltpjTKN2rD7_90xhu8JKZW9pxq7DgYME5WmsLtC6WIG7y7gVPXoyjH6HuK5vLyjfgENHGQ_ |
ContentType | Journal Article |
DBID | CGR CUY CVF ECM EIF NPM 7X8 |
DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed MEDLINE - Academic |
DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) MEDLINE - Academic |
DatabaseTitleList | MEDLINE - Academic MEDLINE |
Database_xml | – sequence: 1 dbid: NPM name: PubMed url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: EIF name: MEDLINE url: https://proxy.k.utb.cz/login?url=https://www.webofscience.com/wos/medline/basic-search sourceTypes: Index Database |
DeliveryMethod | fulltext_linktorsrc |
EndPage | 400; discussion 400-1 |
ExternalDocumentID | 9585771 |
Genre | Journal Article |
GroupedDBID | --- .55 .GJ 0R~ 23M 36B 3V. 53G 5GY 5RE 6J9 7RV 7X7 88E 88I 8AF 8AO 8FI 8FJ 8G5 8R4 8R5 96U AABMB AACMV AADEU AADUE AAEWN AAGKA AAKGS AAOJP AAQQT AARIX AATAA AAWTL ABCQX ABJNI ABKRH ABLUO ABOCM ABPNF ABRHV ABUWG ACARO ACFEJ ACGFO ACGOD ACIHN ACJER ACLFY ACOFE ACOXC ACPRK ACROE ACSIQ ACUAV ACUIR ACXKE ACXMB ADBBV ADHBN ADRRZ AEAQA AENEX AESZF AEWHI AEXNY AFFNX AFKRA AFMOU AFQAA AFRAH AFUIA AGKLV AGNHF AHMBA AIOMO AJXAJ ALIPV ALKWR ALMA_UNASSIGNED_HOLDINGS ALTZF ANDLU ARTOV AZQEC BENPR BKEYQ BKNYI BKSCU BPACV BPHCQ BVXVI CCPQU CDWPY CFDXU CGR CUY CVF DC- DF. DWQXO EBD EBS ECM EIF EJD EMB EMOBN EX3 F5P FHBDP FYUFA GNUQQ GUQSH H13 HCIFZ HMCUK J5H J8X JCYGO K9- L7B M0R M1P M2O M2P M2Q M4V NAPCQ NPM P2P PQQKQ PROAC PSQYO Q2X RIG RWL RXW S0X SCNPE SFC SV3 TAE U5U UDS UKHRP UNMZH WH7 WOW X6Y X7M ZE2 ZGI ZONMY ZRKOI ZSSAH ZXP 7X8 |
ID | FETCH-LOGICAL-p206t-2d8d3d8b7a75cad805e0a211cfe8b00d20d3125052a7ea9575c1b0d3e418737f3 |
ISSN | 0003-1348 |
IngestDate | Sat Aug 17 02:36:57 EDT 2024 Sat Sep 28 07:40:12 EDT 2024 |
IsPeerReviewed | true |
IsScholarly | true |
Issue | 5 |
Language | English |
LinkModel | OpenURL |
MergedId | FETCHMERGED-LOGICAL-p206t-2d8d3d8b7a75cad805e0a211cfe8b00d20d3125052a7ea9575c1b0d3e418737f3 |
Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
PMID | 9585771 |
PQID | 79869359 |
PQPubID | 23479 |
ParticipantIDs | proquest_miscellaneous_79869359 pubmed_primary_9585771 |
PublicationCentury | 1900 |
PublicationDate | 1998-05-01 |
PublicationDateYYYYMMDD | 1998-05-01 |
PublicationDate_xml | – month: 05 year: 1998 text: 1998-05-01 day: 01 |
PublicationDecade | 1990 |
PublicationPlace | United States |
PublicationPlace_xml | – name: United States |
PublicationTitle | The American surgeon |
PublicationTitleAlternate | Am Surg |
PublicationYear | 1998 |
SSID | ssj0004651 |
Score | 2.0883093 |
Snippet | Necrotizing fasciitis is an aggressive soft-tissue infection that in the past has carried a significant mortality rate. One of the most important determinants... |
SourceID | proquest pubmed |
SourceType | Aggregation Database Index Database |
StartPage | 397 |
SubjectTerms | Adolescent Adult Aged Anti-Bacterial Agents - administration & dosage Combined Modality Therapy Debridement - methods Fasciitis, Necrotizing - mortality Fasciitis, Necrotizing - surgery Female Humans Male Middle Aged Retrospective Studies Survival Rate Treatment Outcome |
Title | Aggressive surgical management of necrotizing fasciitis serves to decrease mortality: a retrospective study |
URI | https://www.ncbi.nlm.nih.gov/pubmed/9585771 https://search.proquest.com/docview/79869359 |
Volume | 64 |
hasFullText | 1 |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV3Pa9swFBZrd9lldHRl3Y9Oh96Chx3Zlt1bsqUrpc3GSCDsYmRLGulWuyT2pX_93pMsK4OV_bgYI7AT_Imn70nf9x4hpzLVPC9lHsQ6S4OYx2mQh1oDkWMSsjGYMhq9w9fz9GIZX66SlWtx37tL2vJddf9bX8n_oApjgCu6ZP8B2eGlMAD3gC9cAWG4_hXGk28mW0bxz7bb2Bh2O-hZjEYDWGHTru-NXlLAcocljEa4E2tLO0jDGrdqdGtoOLYIMO7njWo3jXNh7tSgvfGTazjrwZ9W_jR_unaNqqdeTvx1XQrraf_o-zxfV-hE7A-iRsNmz6T70fb7sh964bH0Pj0nAhxCLQsiZstoulBrC5b3UyrZiZvMinT7JRjiCjYwQF9yh1rgegQjQeSXLHdMP_9UnC-vrorFbLXYI3ssQlEnX_EdZ2wy9EzEP_NwHmH4xOKAPO0TATqxqD4jj1R9SL57RKlDlHpEaaPpDqJ0QJRaRGnbUIcoHRA9o4L-gic1eD4ny_PZ4v1F0LfDCO7GYdoGY5lJJrOSC55UQmZhokIB-XulVQbBU45DySJktGPBlciBh1dRCWMqjjLOuGZHZL9uavWCUGAkGjslVEzKWOtE6BIS5UQIFSI_rI7JW_eZCgg3eIYkatV024LnWYpm7mNyZL9ecWerohQ5JJ6cRy__-Ogr8sRPmNdkv9106g0wu7Y8MeCdkMfT2fzzl5_LHlr_ |
link.rule.ids | 315,786,790,31753,33778 |
linkProvider | ProQuest |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Aggressive+surgical+management+of+necrotizing+fasciitis+serves+to+decrease+mortality%3A+a+retrospective+study&rft.jtitle=The+American+surgeon&rft.au=Bilton%2C+B+D&rft.au=Zibari%2C+G+B&rft.au=McMillan%2C+R+W&rft.au=Aultman%2C+D+F&rft.date=1998-05-01&rft.issn=0003-1348&rft.volume=64&rft.issue=5&rft.spage=397&rft.epage=400%3B+discussion+400-1&rft.externalDBID=NO_FULL_TEXT |
thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0003-1348&client=summon |
thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0003-1348&client=summon |
thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0003-1348&client=summon |