[Necrotizing fasciitis in children: own experience and literature data].

OBJECTIVE

To analyze own experience in treating children with necrotizing fasciitis (NF) and literature data regarding clinical features, course of disease, predictors of complications and likelihood of death.

MATERIAL AND

METHODS

We analyzed treatment, follow-up and fatal outcomes in 10 patients aged 4-144 months with NF. Data analysis was performed using the StatTech program.

RESULTS

Mean duration of disease was 1.45±1.17 days. In 2 patients, manifestation of disease was in abdominal wall, in other cases - in limbs. We established the entry gates in 6 children. Most children had concomitant diseases. Diagnosis was based on physical examination and ultrasound. Microbiological examination revealed microflora growth in 5 children: alpha-hemolytic streptococcus, Haemophilus influenzae, pyogenic staphylococcus and mixed flora. Treatment included intensive therapy and surgical treatment (necrectomy), 5 children underwent various methods of extracorporeal detoxification. In 6 cases, HBO sessions were performed. Fatal outcomes occurred in 4 cases: 50% cases with concomitant congenital malformations (tetralogy of Fallot and Hirschsprung's disease), other ones with acute respiratory viral infections. Surgical treatment was not provided in a timely manner in 75% of cases with fatal outcomes.

CONCLUSION

Clinical diagnosis should be the first priority, and identification of the triad of symptoms (ischemic skin lesion surrounded by dense edema, fever, progressive clinical deterioration) allows suspecting necrotizing fasciitis and indications for surgical revision. Early surgical treatment determines favorable course of disease.