Background: Necrotising soft tissue infections (NSTI) are uncommon and remain a devastating disease. This study aims to document mortality rates, assess the value of the laboratory risk indicator for necrotising fasciitis (LRINEC) score as a diagnostic tool and examine outcomes following reconstructive surgery for wound closure.
Methods: A retrospective case note review of patients presenting to our institute between 2004 and 2012 with a histological or clinical diagnosis of necrotising fasciitis were identified.
Results: Thirty-three patients with primary NSTI were identified with a male to female ratio of 1.6:1 and an average age of 50 years. Two patients with secondary reconstruction were identified with a male to female ratio of 1:1 and an average age of 63 years. Twenty patients required admission to the intensive care unit. On average each patient required two tissue debridements under anaesthesia to achieve a healthy wound base suitable for reconstruction. Reconstruction with an anterolateral fasciocutaneous thigh flap (ALT) was carried out in two patients (6%), delayed split skin grafting in thirteen patients (39%) and limb amputation in three patients (9%). Partial flap loss with skin necrosis requiring debridement and advancement occurred in both patients who underwent ALT, whilst complete loss of skin graft occurred in one patient. Thirty-day mortality was 27% with an average time from presentation to death approximately 5 days.
Conclusion: Our experience of managing necrotising soft tissue infections has been mixed. Early diagnosis and aggressive debridement with frequent monitoring and return to theatre are essential. These interventions must be coupled with early administration of antimicrobials and supportive fluid resuscitation to provide optimal treatment in the care of NSTI patients.
Keywords: Necrotising fasciitis, mortality, antimicrobials, soft tissue infections