Necrotizing fasciitis: a critical view.

When treating patients with soft tissue infections, we sometimes have to deal with an extremely lethal infection: necrotizing fasciitis. This requires immediate surgical intervention with fasciectomy and extensive necrotectomy. The cause is a mixed infection with aerobic and anaerobic organisms, especially with group A Streptococcus. Since 1992, 12 patients who had a clinical and histological diagnosis of necrotizing fasciitis have been treated in our department. Risk factors were found in ten patients (83%). The mean age in the study group was 58.3 years (range 32–93 years). A total of 59 operations were performed. The overall mortality rate was 33% (n=4). Two other patients died due to complications of pre-existing leukemia. In spite of multiple wound cultures taken during the first operation, microorganisms could only be identified in two cultures: group A Streptococcus. All other cultures showed no growth of any microorganism. In view of our results, we believe that necrotizing fasciitis can also develop without an infection with bacteria or fungi due to capillary thrombosis. Urgent surgery is needed. [ABSTRACT FROM AUTHOR]