Necrotizing fasciitis: Experience of a burn care team

Ruth L. Bush, Debra A. Reilly, Anne E. Missavage

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1 Scopus citations

Abstract

Necrotizing fasciitis is a life-threatening soft tissue infection characterized by extensive necrosis of the subcutaneous tissues due to progressive bacterial infection and thrombosis of the blood supply. These patients are usually septic and present both critical care and wound care challenges, particularly suitable for the Burn Team. We reviewed our three-year experience, providing care to 45 patients with necrotizing fasciitis. Patients were transferred from an outlying hospital or from another surgical service for wound and intensive care in the Burn Unit. The patients were debrided rapidly and repetitively until evidence of bacteriologic control was obtained by tissue quantitative culture. Extensive dressing changes with topical antibiotics were accomplished daily with conscious sedation techniques within the Burn Unit, frequently using ketamine for analgesia. Attention was particularly given to adequate nutritional support, splinting, and physical therapy. The mean patient age was 43.9 years (range 1 to 81), and 58 percent were male. Six patients died for a mortality rate of 13 percent. Necrotizing fasciitis was caused by drug injection (in 13 patients), trauma (7), perirectal abscess (4), skin infection (4), meningococcemia (3), intraabdominal infection (3), Fournier's gangrene (2), infected pressure ulcer (1), peripheral vascular disease (1), post-operative (1), and idiopathic (6). Strep was the most common organism, but 58 percent were polymicrobial. The mean wound size was 9.8 percent TBSA (range 1 to 30 percent); 16 were truncal, 21 extremity, and 8 perineum. Forty-three patients needed 230 operative debridements total (average 5.35 each), and 64 procedures for closure (58 skin grafts, 3 flaps, and 3 primary closures) in 37 patients. Sixty-two percent of the skin-grafted patients were closed with the first graft (average 1005 cm2). One survivor was allowed to heal secondarily, and another was returned to his managed care facility for closure. The patients required 30.3 days for hospitalization (range 3 to 102). In this selected group of patients with difficult wounds, burn service expertise produced an excellent survival rate of 87 percent. In addition, these patients kept the Burn Team busy and maintained the intensive care unit census.

Original languageEnglish (US)
Pages (from-to)70-77
Number of pages8
JournalWounds
Volume8
Issue number3
StatePublished - May 1 1996

ASJC Scopus subject areas

  • Surgery
  • Medical–Surgical

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    Bush, R. L., Reilly, D. A., & Missavage, A. E. (1996). Necrotizing fasciitis: Experience of a burn care team. Wounds, 8(3), 70-77.