Results of surgical treatment of necrotizing soft tissue infections. A 15-years retrospective cohort study of a single center of emergency surgery.

BACKGROUND

Although rare, necrotizing soft tissue infections carries a high risk of mortality and morbidity. Extensive surgical debridement of necrotic tissues until healthy tissue is the cornerstone of management. Despite this, in-hospital mortality remains high for these patients.

METHODS

We evaluated the experience of an Emergency Surgery center over a 15-year period. We evaluated factors related to in-hospital mortality. Secondary outcomes were assessment of morbidity, need for intensive care admission, risk of amputation, and outcomes related to the timing of surgery.

RESULTS

One hundred and eight patients were included in this retrospective cohort study. All patients, except one (99.1%), underwent surgical debridement. Of these, 64 patients (59.3%) required multiple revisions (2.0 ± 2.7). Negative pressure wound therapy was applied to 52 patients (48.1%), for a mean duration of 21.7 ± 23.3 days. The mortality rate was 25.9% (28 patients). Ninety patients (83.3%) developed a complication during hospitalization, most of which were severe (20 patients grade III and 64 grade IV). Patients operated on within 10 h experienced a reduction in the rate of major complications (P = 0.02). Fourteen patients (13%) underwent limb amputation and 37 patients (34.3%) presented motor deficits at discharge.

CONCLUSIONS

Necrotizing soft tissue infections are a challenge for the emergency surgeon. An accurate diagnosis is not always possible and rapid intervention improves the results. Currently, there are no elements that allow a definitive diagnosis and a determining factor for a correct and accurate diagnostic framework is the competence of the surgeon.