Department of Plastic, Reconstructive and Aesthetic Surgery of Dokuz Eylul University, Izmir, Turkey.
Int Wound J. 2019 Dec;16(6):1347-1353. doi: 10.1111/iwj.13196. Epub 2019 Aug 16.
Necrotising fasciitis (NF) is mostly a polymicrobial, severe soft tissue infection that progresses rapidly, penetrating through the subcutaneous tissue to the fascial planes and the muscles. The pyoderma gangrenosum (PG), on the other hand, is a rare, rapidly progressive (except for the post-surgical PG), autoinflammatory ulcerative skin and soft tissue condition. In this study, we tried to emphasise the importance of diagnosing the NF as well as the PG. Although these two clinical presentations have some standard features, awareness of different symptoms in detail affect the outcome. Any surgical discipline can face NF or PG and, therefore, should be aware of them to decrease the mortality rate. Forty-five patients with NF and PG who were treated between January 2008 and October 2018 were included in the study and evaluated retrospectively for age, sex, localisation, onset of symptoms and diagnosis, predisposing factors, characteristics of tissue defects, laboratory findings, Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) scores, isolated microbiological agents, surgical intervention, and mortality rate. Demographic, laboratory, and clinical data were analysed. Among these 45 patients, 14 patients had PG, and 31 patients had NF. The mean age and SD for the NF and PG groups were 50.80 ± 17.67 and 50.78 ± 12.72, respectively. Five patients had rheumatological disorders; four patients had diabetes mellitus (DM) in the PG group. Males had higher risk than females in NF (odds ratio [OR] = 0.077, 95% confidence interval [CI] 0.017-0.34), and females had higher risk in PG (relative risk [RR] = 5). We compared the LRINEC score of NF patients with PG patients. The mean value of this score was 4.53 for PG patients, and 6.06 for NF patients. Fifteen patients (33.3%) had a radiological evaluation. MRI, CT, and USI were used as imaging modalities. Necrotising fasciitis and PG are two distinct entities that are in general difficult to distinguish. Therefore, differential diagnosis and rapid treatment are crucial for lowering the mortality rate.
坏死性筋膜炎（NF）大多是一种多微生物的严重软组织感染，其进展迅速，穿透皮下组织至筋膜层和肌肉。另一方面，坏疽性脓皮病（PG）是一种罕见的、迅速进展的（除手术后 PG 外）自身炎症性溃疡性皮肤和软组织疾病。在本研究中，我们试图强调诊断 NF 和 PG 的重要性。尽管这两种临床表现有一些共同特征，但对不同症状的详细认识会影响治疗结果。任何外科科室都可能遇到 NF 或 PG，因此，应了解这些疾病以降低死亡率。本研究回顾性分析了 2008 年 1 月至 2018 年 10 月期间收治的 45 例 NF 和 PG 患者的年龄、性别、发病部位、症状和诊断起始时间、诱发因素、组织缺损特征、实验室检查结果、实验室危险指数评分（LRINEC）、分离出的微生物、手术干预和死亡率。对这些患者的人口统计学、实验室和临床数据进行了分析。在这 45 例患者中，14 例为 PG，31 例为 NF。NF 和 PG 组的平均年龄和标准差分别为 50.80±17.67 岁和 50.78±12.72 岁。PG 组有 5 例患者合并风湿性疾病，4 例患者合并糖尿病（DM）。NF 中男性发病风险高于女性（比值比 [OR] = 0.077，95%置信区间 [CI] 0.017-0.34），PG 中女性发病风险高于男性（相对危险度 [RR] = 5）。我们比较了 NF 患者和 PG 患者的 LRINEC 评分。PG 患者的平均评分值为 4.53，NF 患者的平均评分为 6.06。15 例（33.3%）患者进行了影像学评估，使用 MRI、CT 和 USI 作为影像学检查方法。NF 和 PG 是两种截然不同的实体，一般难以区分。因此，鉴别诊断和快速治疗对降低死亡率至关重要。
