Rajappan, K (2013) Comparative Study on the Incidence of Necrotising Fasciitis in Diabetic and Non-Diabetic and Its Outcome. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Necrotizing fasciitis is rapidly progressive and destructive soft tissue infections involving the skin, subcutaneous tissue and superficial fascia, with high mortality and long term morbidity. Patient survival is inversely related to the time interval between onset of disease and initiation of appropriate treatment. Necrotizing soft tissue infections commonly occur in immuno compromised individuals and those with diabetes mellitus or peripheral vascular disease. Mortality from necrotizing fasciitis can be reduced by proper diagnosis, adequate debridement and appropriate antibiotics. Formation of Blister and bullae, standing out as the clinching diagnostic clues , should raise the suspicion of necrotizing fasciitis which are rarely seen in erysipelas or cellulitis.. Cellulitis accompanied by ecchymoses, bullae, dermal gangrene, extensive edema or crepitus suggests an underlying necrotizing infection and mandates operative intervention to confirm the diagnosis and definitively treat the infection. Broad spectrum antibiotics, aggressive surgical debridement and intensive care unit support are essential. Here we intend to compare the incidence of necrotizing fascitis in diabetic and non diabetic patients with respect to age, sex, duration, symptoms, hospital stay and outcome of necrotizing fasciitis in our hospital. Also to study the available treatment and surgical options in our set up for the management of necrotizing fascitis. To study the residual morbidity and mortality after effective management. AIM AND OBJECTIVE: To compare the incidence of necrotizing fascities in diabetic and non diabetic patients with respect to age, sex, duration of symptoms, common site of involvement, precipitating factor, causative organism, duration of hospital stay and outcome. Also to study the available treatment and surgical options in our set up for the management of necrotizing fasciitis. To study the residual morbidity and mortality after effective management. MATERIALS AND METHODS: Type of Study : Prospective study. Place of Study : Rajiv Gandhi Government General Hospital and Madras Medical College, Chennai. Period of Study : One year duration starting from April 2011 to March 2012. Sample Size : 50 cases. Selection of patients: a) Sampling method: Random. b) Inclusion criteria: The patients clinically diagnosed as necrotising Fasciitis. Exclusion criteria: Patients 1. Who were not willing to participate in the study. 2. Those with Peripheral vascular disease, IHD and CVA. 3. Whose age >75yrs. 4. Those underwent wound debridement outside our Hospital were excluded from the study. SUMMARY: • Necrotizing fasciitis is a surgical emergency commonest risk factor is diabetes. • This study was conducted on 50 randomly selected patient in one year period and the incidence among diabetes was 68% and among non-diabetic was 32%. • Common age group affected in diabetic patient were 51- 60yrs (41.2%) with a mean age of 56yrs whereas in nondiabetic patient it was 41-50yrs (50%) with a mean age of 45yrs. • In diabetic patient 19 males (55.9%) and 15 females (44.1%) were affected. whereas in non diabetic patient 10 males (62.5%) and 6 females (37.5%) were affected. • The average duration from the time of onset of symptoms to hospital presentation was 2.06 days in diabetic and 2.81 days in non diabetic patient. • The commonest pre disposing factor in diabetic patient is idiopatic (47.1%) followed by minor trauma (38.2%) whereas in non diabetic minor trauma (68.8%) is most common predisposing factor. • Commonest site of involvement in diabetic is lower limb. • (41.1%) followed by perineum (20.6%) whereas in non- Diabetic lower limb is commonly involved (68.8%). • In diabetic patient polymicrobial organism is common (64.6%) {(streptococcus pyogens and pseudomonas - (38.2%) followed by (streptococcal and E.Coli-17.6%)} whereas in non diabetic patient streptococcus pyogens (56.3%) is most common. • Mean duration of hospital stay in diabetic patient is 30.9 days and in non diabetic patient is 20.5 days. • In diabetic (52.9%) and non diabetic (43.85%) commonest mode of wound healing was by split skin graft. • Mortality rate in diabetic is (17.6%) and non diabetic is (12.5%). CONCLUSION: Incidence of necrotising fasciitis was more common in diabetic. • Necrotizing fasciitis in diabetic is common in the age groups of 51-60 years whereas in non diabetic patient it is 41-50 years. • Males were affected more than female in both diabetic and non diabetic patient. • In diabetic common precipitating factors is idiopathic whereas in non diabetic minor trauma is the common precipitating factor. • Lower extremity is the most common site of involvement in both diabetic and non diabetic patient. • Poly microbial organism was the most common organism in diabetic whereas mono microbial was most common in non diabetic. • Average hospital stay was more in diabetic patient. • Mortality was more in diabetic.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Incidence of Necrotising Fasciitis ; Diabetic and Non-Diabetic ; Outcome ; Comparative Study. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Devi S |
| Date Deposited: | 26 Mar 2018 14:38 |
| Last Modified: | 26 Mar 2018 14:38 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6592 |
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