Necrotizing fasciitis.

Necrotizing fasciitis is a lethal and insidious disease with a high mortality. It often begins in areas exposed to fecal or urinary contamination, and about 70% of cases occur in diabetics. A high index of suspicion should be maintained in diabetic patients with an infection in the perineum, genitalia, thigh, or buttocks. Factors leading to a poor prognosis are increased age and extent of disease at the time of diagnosis, especially myonecrosis. Therapy is primarily radical surgical debridement with adjunctive antibiotic therapy.