Nigerian Journal of Orthopaedics and Trauma

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Case Report: Extremity Necrotizing Fasciitis: Four-year Experience in a Tertiary Hospital

KE Amaefule, IL Dahiru


Background: Necrotizing fasciitis is an uncommon rapidly progressive potentially lethal soft tissue infection characterized by extensive necrosis of the subcutaneous tissue and fasciae often with profound systemic toxaemia and occasionally demanding amputation. The successful treatment of this infection often requires an aggressive approach which includes multiple surgical procedures in order to contain the infection and to reconstruct the damaged parts with its attendant huge financial burden.
Objective: To study the outcome of early amputation as a form of radical debridement VS Repeated debridement and wound resurfacing in the surgical treatment of severe extremity necrotizing fasciitis.
Patients and Method: This is a retrospective observational study. The medical records of patients diagnosed with Necrotizing fasciitis of the extremities and managed solely or jointly with the Plastic/Reconstructive surgeons, by the orthopaedic surgical service of Ahmadu Bello University
Teaching Hospital, Zaria between January 2008 and December 2011 were reviewed.
Result: Thirteen patients were diagnosed and managed with Necrotizing fasciitis by the Orthopaedic Surgical Service. They were 9(69.2%) males and 4(30.8%) females. Two (15.4%) were children, one (7.7%) adolescent. Ten (76.9%) patients were above 45years. The median period from onset of disease to presentation was sixteen days. The upper limb was involved in only two (15.4%) patients and the lower limb in eleven (84.6%) patients. Eight (61.5%) of them were polymicrobial infections while four (30.8%) were Monomicrobial. One (7.7%) of the culture results could not be traced. Eight (61.5%) had a good outcome of treatment, two (15.4%) were discharged against medical advice while three (23.1%) patients died of their diseases.
Conclusion: Most of our patients present late to hospital. Some of the patients who cannot afford the financial implication of prolong hospital stay and repeated surgery the treatment deserves often asks for discharge against medical advice before the completion of their treatment as shown by the study. Early amputation could be life saving, with a good outcome and readily acceptable by most of these patients.

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