Plastic and Reconstructive Surgery, Dokuz Eylul University, Faculty of Medical, İnciraltı, Izmir, Turkey.
Int Wound J. 2013 Aug;10(4):466-72. doi: 10.1111/j.1742-481X.2012.01006.x. Epub 2012 Jun 13.
Necrotising fasciitis (NF) is characterised by rapidly spreading necrosis of the soft tissue and fascia. It is rare but can be fatal when not managed properly. The aim of this study is to evaluate the diagnosis, treatment and results such as mortality, morbidity and reconstructive options of NF localised in the central part of the body. The main goal is to emphasise upon the clinical symptoms for early diagnosis which is the most important factor in saving the lives of these patients. Between January 2000 and December 2010, 30 patients with NF localised in central parts of the body were treated. Six of the patients were female (20%) and the others were male (80%). The mean age was 54·03 years (ranged between 26 and 83 years). The average time from the onset of symptoms to diagnosis was 6 days, ranging from 2 to 11 days. The localisation of NF was perineum in 24 patients (80%); inguinal and thigh region in 5 patients (16·7); and back in 1 patient (3·3%). The hospitalisation time was varying between 17 and 32 days (mean 23 days). Six patients (20%) died and 24 patients (80%) survived. All non-survivors had risk factors and secondary comorbidities such as immunosuppression, chronic cardiac failure, and diabetes with high glucose level. Survivors also underwent repeated debridement operation 2-4 times. Reconstructive procedures were split-thickness skin graft (STSG) in eight patients (33·3%), fasciocutaneous flaps in four patients (16·6%), fasciocutaneous flap + STSG in six patients (25%), scrotal flap + STSG in two patients (6·6%), scrotal flap in two patients (6·6%) and musculocutaneous flap + STSG in one patient (3·3%). There was no major complication such as flap and graft loss, after reconstructive procedures. Early diagnosis of NF may be the lifesaving factor. Amuputation can save the patient's life in the case of NF in the extremities; however, this is not an option for NF in central parts of the body. In these cases, when NF is suspected, early debridement of necrotic tissues should be performed. As soon as the infection and the spread of the necrosis are controlled, reconstruction should be considered.
坏死性筋膜炎（NF）的特征是软组织和筋膜迅速坏死。它很少见，但如果处理不当可能是致命的。本研究旨在评估 NF 在身体中部的定位的诊断、治疗和结果，如死亡率、发病率和重建选择。主要目的是强调早期诊断的临床症状，这是挽救这些患者生命的最重要因素。2000 年 1 月至 2010 年 12 月，共治疗 30 例 NF 定位在身体中部的患者。其中 6 例为女性（20%），其余为男性（80%）。平均年龄为 54.03 岁（26-83 岁）。从症状发作到诊断的平均时间为 6 天，范围为 2-11 天。NF 的定位为会阴 24 例（80%）；腹股沟和大腿区 5 例（16.7%）；背部 1 例（3.3%）。住院时间为 17-32 天（平均 23 天）。6 例（20%）死亡，24 例（80%）存活。所有非幸存者都有风险因素和继发性合并症，如免疫抑制、慢性心力衰竭和高血糖水平的糖尿病。幸存者还接受了 2-4 次重复清创手术。重建手术为 8 例（33.3%）行中厚皮片移植（STSG），4 例（16.6%）行筋膜皮瓣，6 例（25%）行筋膜皮瓣+STSG，2 例（6.6%）行阴囊皮瓣+STSG，2 例（6.6%）行阴囊皮瓣，1 例（3.3%）行肌皮瓣+STSG。在重建手术后，没有出现皮瓣和移植物丢失等主要并发症。NF 的早期诊断可能是挽救生命的因素。在 NF 发生于四肢的情况下，截肢可以挽救患者的生命；然而，这不是身体中部 NF 的选择。在这些情况下，一旦怀疑 NF，就应尽早进行坏死组织的清创。一旦感染和坏死的扩散得到控制，就应考虑重建。
