Necrotizing fasciitis: a persistent surgical problem.

Necrotizing fasciitis is a rare but specific clinical entity which, if not diagnosed early and treated aggressively, is rapidly fatal. The disease was first described during the Civil War and continues to be associated with a 50% mortality. The infectious process is diagnosed by the presence of a widespread fascial necrosis with extensive undermining of the adjacent tissues. The initial mechanism of injury as well as the location and etiologic agent of the suppurative fasciitis may vary. A review of 41 cases of necrotizing fasciitis occurring over a 22-year period disclosed an overall mortality of 39%. Most often, the mortality was related to the severity of the associated diseases and a failure to recognize the disease process promptly. The rate may be lowered by early recognition and prompt surgical intervention coupled with intensive supportive therapy.