Research Article
Volume 13 Issue 4 - 2022
Necrotizing Fasciitis: An Orthopedic Perspective Diagnosis and Management Study
Mohammed Abdullah Alshahrani1*, Ali Abdullah Alshehri2 and Mubasher Maqboul3
1Orthopedic Senior Resident (AFHSR), Khamis Mushait, KSA
2Orthopedic Junior Resident (AFHSR), Khamis Mushait, KSA
3Consultant Orthopedic and Arthroplasty Surgeon, Program Director of Orthopedic Surgery in King Fahad Military Hospital (AFHSR), Khamis Mushait, KSA
*Corresponding Author: Mohammed Abdullah Alshahrani, Orthopedic Senior Resident, Armed Force Hospital of Southern Region (AFHSR), Khamis Mushait, KSA.
Received: December 16, 2021; Published: March 21, 2022


Background: Necrotizing fasciitis (NF) is described as an uncommon life-threatening condition characterized by progressive necrosis of subcutaneous tissue and deep fascia planes leading to death if not recognized early and debrided. The main dilemma in the management of Necrotizing fasciitis is its early diagnosis to allow appropriate management.

Objective: The objective of this retrospective study was to show results of early diagnosis and debridement of Necrotizing fasciitis and determine mortality outcomes.

Methods: Patients with diagnosis of NF in our institution from November 2015 to November 2019 were reviewed retrospective for their clinical presentation, laboratory, risk Indicator of Necrotizing fasciitis leads Score (LRINEC), debridement and mortality.

Results: 25 patients with diagnosis of NF, 17 idiopathic (68%), 5 perirectal abscess (20%) and 3 subcutaneous injection of spinal anesthesia in lumbar region (12%).

Common comorbidity were diabetes mellitus (75%), chronic renal disease (66%), peripheral vascular disease (31%).

Clinical presentation pain out of proportion (71%), Erythema (87%), Fever < 38c (82%), skin necrosis bulle (77%).

LRINEC score was < 8 in 19 patients (76%). The infecting organisms were polymicrobial (69%) while (31%) were mono microbial. Average time to operative debridement is 15 hours range (10 - 72) with 4.7 debridement per patient (range 3 - 7). Overall Mortality is 2 patients (8%).

Conclusion: Early diagnosis and debridement leads to reduced mortality in necrotizing fasciitis.


Keywords: LRINEC Score; Necrotizing Fasciitis; Mortality Rate; Risk Factors


  1. Fernando SM., et al. “Necrotizing Soft Tissue Infection: Diagnostic Accuracy of Physical Examination, Imaging, and LRINEC Score: A Systematic Review and Meta-Analysis”. Annals of Surgery 1 (2019): 58-65.
  2. Kim YH., et al. “Managing necrotising fasciitis to reduce mortality and increase limb salvage”. Journal of Wound Care 9 (2018): S20-S27.
  3. Jamal N and Teach SJ. “Necrotising fasciitis”. Pediatric Emergency Care 12 (2011): 1195-1199.
  4. Sultan HY., et al. “Necrotizing fasciitis”. British Medical Journal 345 (2012): e4274.
  5. Eke N. “Fournier’s gangrene: a review of 1726 cases”. British Journal of Surgery 6 (2000): 718-728.
  6. Erichsen Andersson A., et al. “Signs, symptoms and diagnosis of necrotizing fasciitis experienced by survivors and family: a qualitative Nordic multi-center study”. BMC Infectious Diseases 1 (2018): 429.
  7. Fais P., et al. “Necrotizing fasciitis: case series and review of the literature on clinical and medico-legal diagnostic challenges”. International Journal of Legal Medicine 5 (2018): 1357-1366.
  8. Hefny AF., et al. “Necrotizing fasciitis: a challenging diagnosis”. European Journal of Emergency Medicine 1 (2007): 50-52.
  9. Kaafarani HM and King DR. “Necrotizing skin and soft tissue infections”. Surgical Clinics of North America 1 (2014): 155-163.
  10. Levine EG and Manders SM. “Life-threatening necrotizing fasciitis”. Clinics in Dermatology 2 (2005): 144-147.
  11. Catena F., et al. “Necrotizing fasciitis: a dramatic surgical emergency”. European Journal of Emergency Medicine 1 (2004): 44-48.
  12. Carter PS and Banwell PE. “Necrotising fasciitis: a new management algorithm based on clinical classification”. International Wound Journal 3 (2004): 189-198.
  13. Puvanendran R and Huey JC. “Necrotizing fasciitis”. Canadian Family Physician 10 (2009): 981-987.
  14. Vijayakumar A., et al. “Necrotizing fasciitis: diagnostic challenges and current practices”. International Scholarly Research Notices (2014): 208072.
  15. Goh T., et al. “Early diagnosis of necrotizing fasciitis”. British Journal of Surgery 1 (2014): e119-e125.
  16. Wong CH., et al. “Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality”. Journal of Bone and Joint Surgery. American Volume 8 (2003): 1454-1460.
  17. Wong CH., et al. “The LRINEC (laboratory risk indicator for necrotizing fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections”. Critical Care Medicine 7 (2004): 1535-1541.
  18. Bechar J., et al. “Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: a systematic review of the literature”. Annals of the Royal College of Surgeons of England5 (2017): 341-346.
  19. Liu TJ., et al. “Predisposing factors of necrotizing fasciitis with comparison to cellulitis in Taiwan: A nationwide population-based case-control study”. Journal of the Formosan Medical Association 1 (2020): 18-25.
  20. Hedetoft M., et al. “Incidence, comorbidity and mortality in patients with necrotising soft-tissue infections, 2005-2018: a Danish nationwide register-based cohort study”. BMJ Open10 (2020): e041302.
  21. Cunningham JD., et al. “Necrotizing fasciitis: a plea for early diagnosis and treatment”. Mount Sinai Journal of Medicine 4-5 (2001): 253-261.
  22. Groth D and Henderson SO. “Necrotizing fasciitis due to appendicitis”. American Journal of Emergency Medicine 6 (1999): 594-596.
  23. Legbo JN and Legbo JF. “Bacterial isolates from necrotizing fasciitis: a clinico-pathological perspective”. Nigerian Journal of Medicine 2 (2007): 143-147.
  24. Wang JM and Lim HK. “Necrotizing fasciitis: eight-year experience and literature review”. Brazilian Journal of Infectious Diseases 2 (2014): 137-143.
  25. Misiakos EP., et al. “Current concepts in the management of necrotizing fasciitis”. Frontiers in Surgery 1 (2014): 36.
  26. Anaya DA and Dellinger EP. “Necrotizing soft-tissue infection: diagnosis and management”. Clinical Infectious Diseases 5 (2007): 705-710.
Citation: Mohammed Abdullah Alshahrani., et al. “Necrotizing Fasciitis: An Orthopedic Perspective Diagnosis and Management Study”. EC Orthopaedics 13.4 (2022): 95-102.

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