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World Journal of Emergency Surgery
Published in: World Journal of Emergency Surgery 1/2016

Open Access 01-12-2016 | Research article

Triple diagnostics for early detection of ambivalent necrotizing fasciitis

Authors: Falco Hietbrink, Lonneke G. Bode, Louis Riddez, Luke P. H. Leenen, Marijke R. van Dijk

Published in: World Journal of Emergency Surgery | Issue 1/2016

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Abstract

Background

Necrotizing fasciitis is an uncommon, rapidly progressive and potential lethal condition. Over the last decade time to surgery decreased and outcome improved, most likely due to increased awareness and more timely referral. Early recognition is key to improve mortality and morbidity. However, early referral frequently makes it a challenge to recognize this heterogeneous disease in its initial stages. Signs and symptoms might be misleading or absent, while the most prominent skin marks might be in discrepancy with the position of the fascial necrosis. Gram staining and especially fresh frozen section histology might be a useful adjunct.

Methods

Retrospective analysis of 3 year period. Non-transferred patients who presented with suspected necrotizing fasciitis are included. ASA classification was determined. Mortality was documented.

Results

In total, 21 patients are included. Most patients suffered from severe comorbidities. In 11 patients, diagnoses was confirmed based on intra-operative macroscopic findings. Histology and/or microbiotic findings resulted in 6/10 remaining patients in a change in treatment strategy. In total, 17 patients proved to suffer necrotizing fasciitis. In the cohort series 2 patients died due to necrotizing fasciitis

Conclusion

In the early phases of necrotizing fasciitis, clinical presentation can be ambivalent. In the present cohort, triple diagnostics consisting of an incisional biopsy with macroscopic, histologic and microbiotic findings was helpful in timely identification of necrotizing fasciitis.
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Metadata
Title
Triple diagnostics for early detection of ambivalent necrotizing fasciitis
Authors
Falco Hietbrink
Lonneke G. Bode
Louis Riddez
Luke P. H. Leenen
Marijke R. van Dijk
Publication date
01-12-2016
Publisher
BioMed Central
Published in
World Journal of Emergency Surgery / Issue 1/2016
Electronic ISSN: 1749-7922
DOI
https://doi.org/10.1186/s13017-016-0108-z

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