Necrotizing soft tissue infections of the upper extremity: a case series.

Four cases of necrotizing soft tissue infections of the upper extremity are presented. Each involved minor wounds to the hand that gradually progressed to fulminant infection. Two of the patients reported a history of alcohol abuse. One patient had psychiatric illness that led to delay in recognizing the infection and seeking intervention. The causative organism in all cases was group A beta hemolytic streptococcus. Fortunately, none of the patients suffered loss of the affected extremity, although long-term function is limited. The necrotizing soft tissue infection encountered in these cases represents a less severe presentation than classic necrotizing fasciitis. Necrotizing soft tissue infections are properly recognized as a spectrum of disease and can, as in these cases, follow a prolonged progression with limited systemic involvement. The current literature regarding diagnosis and treatment of necrotizing soft tissue infections is reviewed.