Aims and objectives: Necrotising fasciitis is a severe form of soft tissue infection with the potential to spread rapidly and can result in significant soft tissue defects and mortality. The upper limb is less commonly affected compared with other sites (6-27%1-3). Internationally, small studies have demonstrated factors predicting morbidity and mortality4,5. These however have not included an Australasian population. We aim to investigate necrotising fasciitis of the upper limb, identifying those patients at risk and assessing patient function and satisfaction.
Methods: Retrospective review of all patients treated with necrotising fasciitis of the upper limb at Counties Manukau Health (CMH) Plastics, Hand and Reconstructive unit between 1st January 2006 – 1st December 2015. Patient demographics, clinical features, surgical parameters, reconstruction methods and outcomes were investigated. Subjective outcomes were assessed by the QuickDASH and Patient Evaluation Measure (PEM) questionnaires.
Observations and Results: 15 patients were identified. Mean follow up time was 23.7 months. Mean age at admission: 54 ± 21 years. The most common organism isolated was Streptococcus pyogenes (73%). Patients underwent a mean of 3.4 ± 2.2 debridements. Three patients (20%) died all due to disease specific causes. Significant variables associated with mortality were a history of hypertension (p=0.044), age (mean age 80 ± 10 years versus 48 ± 18 years in survivors, p=0.017) and amputation of a limb (p=0.029). Of the survivors, mean QuickDASH score was 21 ± 14, PEM2 77% ± 14 and PEM3 87% ± 13.
Discussion & conclusion:
This study has shown in our population older age, hypertension and the need for amputation to significantly impact mortality. This gives different results to international studies on necrotizing fasciitis of the upper limb. Multiple debridements are common and reconstruction is usually required. Patients report a higher level of disability than a normal population but high levels of satisfaction.