Necrotizing fasciitis must be considered in a diabetic with cutaneous ulceration. A case report of limb salvage in a 48-year-old diabetic female with progressive necrotizing fasciitis is presented. Methods of early diagnosis including clinical signs, radiographs, and soft tissue biopsy of the involved extremity are reviewed. The microbiology of the disease is also discussed. A modification of the Orr technique using infrequent dressing changes in the management of necrotizing fasciitis is presented. In our case this resulted in preservation of life and a functional limb.
Get full access to this article
View all access options for this article.
References
1.
AltmeierW.A.FullenW.D.Prevention and treatment of gas gangrene. J. A. M. A., 217: 806–813, 1971.
2.
BessmanA.N.WagnerW.Nonclostridial gas gangrene. Report of 48 cases and review of the literature. J. A. M. A., 233: 958–963, 1975.
3.
CrosthwaitR.Q.Jr.CrosthwaitR.W.JordanG.L.Necrotizing fasciitis. J. Trauma, 4: 149–157, 1964.
4.
FisherJ.R.ConwayM.J.TakeshitaR.T.SandovalM.R.Necrotizing fasciitis: Importance of roentgenographic studies for soft-tissue gas. J. A. M. A., 241: 803–806, 1979.
5.
GiulianoA.LewisF.Jr.HadleyK.BlaisdellF.W.Bacteriology of necrotizing fasciitis. Am. J. Surg., 134: 52–57, 1977.
MillerJ.D.The importance of early diagnosis and surgical treatment of necrotizing fasciitis. Surg. Gynecol. Obstet., 157: 197–200, 1983.
9.
OrrH.W.The treatment of acute osteomyelitis by drainage and rest. J. Bone Joint Surg., 9: 733–739, 1927.
10.
ReaW.J.WyrickW.J.Jr.Necrotizing fasciitis. Ann. Surg., 172: 957–964, 1970.
11.
RouseT.M.MalangoniM.A.SchulteW.J.Necrotizing fasciitis. A preventable disaster. Surgery, 92: 765–770, 1982.
12.
SapicoF.L.WitteJ.L.CanawatiH.N.MontgomerieJ.Z.BessmanA.N.The infected foot of the diabetic patient: Quantitative microbiology and analysis of clinical features. Rev. Infect. Dis., 6: S171–S175, 1984.
13.
StamenkovicI.LewP.D.Early recognition of potentially fatal necrotizing fasciitis. The use of frozen-section biopsy. N. Engl. J. Med., 310: 1689–1693, 1984.
14.
StoneH.H.MartinJ.D.Jr.Synergistic necrotizing cellulitis. Ann. Surg., 175: 702–711, 1972.
15.
Van BeekA.ZookE.YawP.GardnerR.SmithR.GloverJ.L.Nonclostridial gas-forming infections. A collective review and report of seven cases. Arch. Surg., 108: 552–557, 1974.
