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Med J Armed Forces India. 2004 January; 60(1): 97.
Published online 2011 July 21. doi:  10.1016/S0377-1237(04)80189-8
PMCID: PMC4923481

AGGRESSIVENESS - THE KEY TO A SUCCESSFUL OUTCOME IN NECROTIZING SOFT TISSUE INFECTION: REPLY

Dear Editor,

I thank the authors for reading the article with keen interest, appreciating the work and sending their expert suggestions. Comments about their observations are as under:

  • 1.
    Necrotizing soft tissue infection is a dreaded disease and requires early recognition, prompt, aggressive and repeated debridement. Mortality rate in this condition has been reported high by some authors in literature as mentioned during the past decade. This is related to the delayed surgical intervention, advanced age and in patients with concurrent diabetes mellitus. Recent studies have reported a mortality rate of 9-20% in patients treated by prompt, aggressive surgery, broad spectrum antibiotics and hyperbaric oxygen therapy [1]. Cabrera et al have reported survival rate upto 87% in necrotizing gangrene of the genitalia and perineum [2].
  • 2.
    Diverting colostomy may be required in some patients of perineal and scrotal involvement and the surgeon should be experienced for the same, but this was not considered necessary in these patients and there was no significant contamination of the wound to warrant diversion.
  • 3.
    Repeated blood transfusions were given in twelve patients in this study after the aggressive debridement and there was significant improvement in the general condition of these patients but this remains an adjunct therapy.
  • 4.
    Penicillin G [3] and clindamycin have a definite role in streptococcal and clostridial necrotizing soft tissue infections and have shown good results in combination with high doses of ampicillin and third generation cephalosporins. The IV metronidazole used in combination produces equally good results. However, in this study emphasis was on aggressive, early surgical debridement and available broad spectrum antibiotics were used with good results. The best outcome is obtained in patients where surgery was aggressive and broad spectrum antibiotics were used as adjunctive therapy combined with blood transfusions and hyperbaric oxygen therapy if readily available.

References

1. Mavnor M. Necrotizing fascitis. www.emedicine.com updated 24 April 2002.
2. Cabrera H, Skoczdopole L, Marini M, Della Giovanna P, Saponaro A, Echeverria C. Necrotizing gangrene of the genitalia and perineum. Int J Dermatol. 2002;41(12):847–851. [PubMed]
3. Zamboni WA, Mazolewski PJ, Erdmann D. Evaluation of penicillin and hyperbaric oxygen in the treatment of streptococcal myositis. Ann Plast Surg. 1997;39(2):131–136. [PubMed]

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