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Wednesday, 18 August 2021 05:59

Predisposing Factors, Management and Outcomes of Necrotizing Fasciitis at Al-Thawra Modern General Hospital, Yemen Featured

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Original Research:

Yasser Abdurabou Obadiel, Mohammed Hamood Q. Alyan

 

 

Abstract

 

Background: Necrotizing fasciitis (NF) still a life-threatening condition in Yemen.

Aim: The aims of this study were to identify the predisposing factors, management and outcomes of NF among Yemeni patients.

Methods: A descriptive study was conducted at Al-Thawra Modern General Hospital located in Sana’a, Yemen. All medical records of patients with confirmed NF admitted to the Surgery Department between January 2020 and January 2021 were reviewed.

Results: The study enrolled 54 patients diagnosed with NF. Male patients were 43 (79.6%) and female patients were 11 (20.3%). The age range was 9 – 75 years old.  The incidence of NF increased with age and the peak age incidence was at 46 – 60 years (33.3%). Similarly, the incidence of NF increased with male gander (79.6%), in comorbid patients (64.8%) especially diabetic mellitus (DM) (37%). The etiologies of NF were trauma (16.7%) and perianal abscess (14.8%). However, 27.8% of NF patients didn’t have specific cause. Most involving areas were lower limb (53.5%) followed by perineum (14.4%). The defected wound after complete debridement treated by skin graft in (32.5%) and primary closure in (27.5%). The mortality rate was 27.7% (n = 15); 60% (n = 9) of them died on the first five days. The most reason of death was septic shock (73.2%). The mortality rate was 66.6% among male compared to 33.3% among female. The higher mortality rate was reported among patients who presented in shocked/toxic (73.3%), comorbid patients (73.3%), bedridden and restricted patients (66.6%), rural patients (66.6%) and patients aged > 60 years (46.6%).

Conclusion: NF still represents a life-threatening condition with challenges in diagnosis. Incidence and mortality rate of NF are common in male gander, an elderly patient, or in who suffers of comorbidities; especially DM.

Keywords: Necrotizing fasciitis, Predisposing factors, Outcomes, Management, Yemen

 

Yasser Abdurabou Obadiel1, 2, Mohammed Hamood Q. Alyan3*
1 Surgery Department, Faculty of Medicine and Health Sciences, Sana’a University, Yemen
2 General Coordinator, Scientific Council of Surgery, Arab Board of Health Specialization, Sana'a center, Yemen
3 Surgery resident, Scientific Council of Surgery, Arab Board of Health Specialization, Sana'a Center, Yemen
 
 
For Correspondence:
Mohammed H. Q. Alyan*
Scientific Council of Surgery, Arab Board of Health Specialization, Sana'a Center, Sana’a, Yemen. Tel: +967 775 892 250;
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
 

To cite this article:

Obadiel YA, Alyan MHQ. Predisposing factors, management and outcomes of necrotizing fasciitis at Al-Thawra Modern General Hospital, Yemen. Annals of Medicine & Health. 2021;3(2):25–30.

 

References

  1. McHenry CR, Compton CN. Soft tissue infections. Problems in General Surgery. Malangoni MH, Soper NJ, Eds. Lippincott Williams & Wilkins, Philadelphia. 2002, p 7.
  2. Kaul R, McGeer A, Low DE, Green K, Schwartz B. Population-based surveillance for group A streptococcal necrotizing fasciitis: Clinical features, prognostic indicators, and microbiologic analysis of seventy-seven cases. Ontario Group A Streptococcal Study. Am J Med. 1997 Jul;103(1):18-24. doi: 10.1016/s0002-9343(97)00160-5.
  3. Mulla ZD, Gibbs SG, Aronoff DM. Correlates of length of stay, cost of care, and mortality among patients hospitalized for necrotizing fasciitis. Epidemiol Infect. 2007 Jul;135(5):868-76. doi: 10.1017/S0950268806007448. Epub 2006 Nov 3.
  4. Hongladaromp C, Chareonsil B, Phadhana-anake O. Predictors on mortality from necrotizing fasciitis in Sawanpracharak Hospital, NakhonSawan, Thailand. Chiang Mai Med J. 2009;48(4):135–142.
  5. Goh T, Goh LG, Ang CH, Wong CH. Early diagnosis of necrotizing fasciitis. Br J Surg. 2014 Jan;101(1): e119-25. doi: 10.1002/bjs.9371. Epub 2013 Nov 29.
  6. Roje Z, Roje Z, Matić D, Librenjak D, Dokuzović S, Varvodić J. Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs. World J Emerg Surg. 2011 Dec 23;6(1):46. doi: 10.1186/1749-7922-6-46.
  7. Brewer GE, Meleney FL. Progressive gangrenous infection of the skin and subcutaneous tissues, following operation for acute perforative appendicitis: a study in symbiosis. Ann Surg. 1926 Sep;84(3):438-50. doi: 10.1097/00000658-192684030-00017.
  8. Yeung YK, Ho ST, Yen CH, Ho PC, Tse WL, Lau YK, et al.; Hong Kong Society for Surgery of the Hand. Factors affecting mortality in Hong Kong patients with upper limb necrotising fasciitis. Hong Kong Med J. 2011 Apr;17(2):96-104.
  9. Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am. 2003 Aug;85(8):1454-60. PMID: 12925624.
  10. American Academy of Pediatrics. Committee on Infectious Diseases. Severe invasive group A streptococcal infections: a subject review. Pediatrics. 1998;101:136-140. doi: https://doi.org/10.1542/peds.101.1.136.
  11. Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, Machairas A. Current concepts in the management of necrotizing fasciitis. Front Surg. 2014 Sep 29;1:36. doi: 10.3389/fsurg.2014.00036.
  12. McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. Determinants of mortality for necrotizing soft-tissue infections. Ann Surg. 1995;221(5):558-563.
  13. Bair MJ, Chi H, Wang WS, Hsiao YC, Chiang RA, Chang KY. Necrotizing fasciitis in southeast Taiwan: clinical features, microbiology, and prognosis. Int J Infect Dis. 2009;13(2):255-260. 
  14. Dworkin MS, Westercamp MD, Park L, McIntyre A. The epidemiology of necrotizing fasciitis including factors associated with death and amputation. Epidemiol Infect. 2009;137(11):1609-1614.
  15. Salvador VB, San Juan MD, Salisi JA, Consunji RJ. Clinical and microbiological spectrum of necrotizing fasciitis in surgical patients at a Philippine university medical centre. Asian J Surg. 2010 Jan;33(1):51-8. doi: 10.1016/S1015-9584(10)60009-7.
  16. Ozalay M, Ozkoc G, Akpinar S, Hersekli MA, Tandogan RN. Necrotizing soft-tissue infection of a limb: clinical presentation and factors related to mortality. Foot Ankle Int. 2006 Aug;27(8):598-605. doi: 10.1177/107110070602700806.
  17. Mouzopoulos G, Stamatakos M, Tzurbakis M, Batanis G, Michou E, Mouzopoulos D, et al. Lower extremity infections by Vibrio vulnificus. Chirurgia (Bucur). 2008 Mar-Apr;103(2):201-3.
  18. Liu YM, Chi CY, Ho MW, Chen CM, Liao WC, Ho CM, et al. Microbiology and factors affecting mortality in necrotizing fasciitis. J Microbiol Immunol Infect. 2005 Dec;38(6):430-5.
  19. Elliott DC, Kufera JA, Myers RA. Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Ann Surg. 1996 Nov;224(5):672-83. doi: 10.1097/00000658-199611000-00011.
  20. Shaikh N, El-Menyar A, Mudali IN, Tabeb A, Al-Thani H. Clinical presentations and outcomes of necrotizing fasciitis in males and females over a 13-year period. Ann Med Surg (Lond). 2015 Sep 14;4(4):355-60. doi: 10.1016/j.amsu.2015.09.005.

 

 

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