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A prospective study of a cohort of patients with necrotizing fasciitis at a level 2 hospital in Sri Lanka

Authors:

Janaka Perera ,

District General Hospital Polonnaruwa, LK
About Janaka
Surgical Department
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Piyal Kurukulasooriya

District General Hospital Polonnaruwa, LK
About Piyal
Surgical Department
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Abstract

Necrotizing fasciitis is a rapidly progressive inflammation and necrosis of soft tissues and fascia, accompanied by severe systemic toxicity. In some cases early diagnosis is challenging. Objective of this study is to identify basic investigations that will aid in early diagnosis in such equivocal cases.


This is a prospective study. Patients who underwent wound debridement for clinically diagnosed necrotizing fasciitis and suspected necrotizing fasciitis at a level 2 hospital in Sri Lanka were included in the study. All together there were 24 patients who were diagnosed to have necrotizing fasciitis with intraoperative findings. In all patients we did full blood count [FBC], C-reactive protein [CRP], random blood sugar [RBS], Arterial blood gas analysis [ABG], plain x-ray films of affected area and wound swab culture and ABST before surgical intervention. Mean age was 67.2 [range: 38-85] years. Diabetes mellitus was a co‐morbidity in 67% of patients. Commonest affected area was the lower limbs. Out of all patients 62% of patients had a history of muddy water contact. All the patients had WBC more than 15,000 where as 58% of patients had WBC more than 25,000. CRP was more than 150 in 83% patients. Among all 54% of patients' plain x-rays were positive for soft tissue gas. Majority of wound swab cultures were poly microbial. Commonest organisms were Streptococcus species, Staphylococcus and enterobac-teriaceae.  
Overall death rate was 42% in this study.  Among 14 patients who were diagnosed on admission, 3 patients died. Death rate was 21%.  Among 10 patients whose diagnoses got delayed, 7 patients died. Death rate was 70%.


A high clinical suspicion of necrotizing fasciitis is needed in an elderly patient presenting with cutaneous infection causing swelling, pain and erythema, with co‐morbidity of diabetes. High WBC, High CRP and presence of soft tissue gas in plain x-rays are highly suggestive for underline necrotizing fasciitis. Diagnostic score for Necrotising fasciitis can be made using these basic investigations and x-ray findings which need to be validated in further studies.

How to Cite: Perera J, Kurukulasooriya P. A prospective study of a cohort of patients with necrotizing fasciitis at a level 2 hospital in Sri Lanka. Sri Lanka Journal of Surgery. 2021;39(1):30–3. DOI: http://doi.org/10.4038/sljs.v39i1.8783
Published on 31 Mar 2021.
Peer Reviewed

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