Necrotizing Fasciitis: A Comparative Analysis of 56 Cases: PATIENTS AND METHODS

3 Dec
2009

This is a four-year prospective descriptive study of all consecutive patients with NF treated at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, from January 2001 to December 2004. Approval for the study was obtained from the hospital’s ethical committee on research. Permission to include the patients in the study was sought from each patient or their parents, and 100% participation was obtained from all the patients who presented within the study period. The study included all patients with diffuse necrotizing soft-tissue infections, according to the known standards of classification of soft-tissue infections. Patients with can-crum oris (noma) or Fournier’s gangrene were excluded. This is because patients with the former are being managed in a specialized hospital built for that purpose in the same city, while those with the later are being managed mainly by the urologists in our center. All the patients were admitted and resuscitated. Each patient was thoroughly evaluated at initial assessment to determine the exact nature of the infection and ascertain the involvement, or otherwise, of other systems. This included detailed clinical evaluation (plus nutritional assessment), clinical photography, relevant microbiological, hematological, immunological, chemical, radiological and histological investigations. Blood samples, surface swabs and tissues were subjected to aerobic cultures only. Standard clinical (including anthropometric) and laboratory measures were used to assess the nutritional status. Broad-spectrum antibiotics were administered pending results of culture and sensitivity. Tetanus toxoid was also administered. Wounds were cleaned regularly with hydrogen peroxide, irrigated with normal saline and dressed with natural honey. Nutritional, physical and other forms of rehabilitation were instituted when necessary. Major surgical debridements were carried out in the operating room under general anesthesia and subsequently repeated when necessary.

Wound resurfacing was by second intention, direct suturing, split-thickness skin grafting (STSG) or flap cover—depending on the nature of the wound and other variables that each patient presented with. All necessary information on each patient was entered into a proforma and later transferred into the computer for analysis.
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