Triple diagnostics for early detection of ambivalent necrotizing fasciitis
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RESEARCH ARTICLE
Open Access
Triple diagnostics for early detection of ambivalent necrotizing fasciitis Falco Hietbrink1* , Lonneke G. Bode2, Louis Riddez3, Luke P. H. Leenen1 and Marijke R. van Dijk4
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. Keywords: Necrotizing fasciitis, Early recognition, Triple diagnostics, Histology, Fresh frozen section
Background Necrotizing fasciitis is a relatively rare disease, which describes a group of infections that comprises skin, soft tissue and muscle and swiftly can spread through fascial planes [1–3]. The disease can be rapidly progressive and can have devastating outcome with many patients not surviving the infection (up to 70 % mortality rate reported in past series) [2]. Early diagnosis followed by immediate and thorough surgical debridement of affected tissue is necessary to prevent mortality and curb the systemic effects from resultant sepsis. However, diagnosis in the early stages can be challenging [4, 5]. Patients with necrotizing fasciitis might be brought to the ICU because of their sepsis without known cause and later prove unresponsive to resuscitation therapy [6, 7]. In a systematic review, a close correlation between the percentage of * Correspondence: [email protected] 1 Department of surgery, University Medical Center Utrecht, Utrecht, The Netherlands Full list of author information is available at the end of the article
initially missed cases and the mortality rate in the presented cohort series has been described [8]. A 75 % mortality reduct
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