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Logo of mjafiGuide for AuthorsAbout this journalExplore this journalMedical Journal, Armed Forces India
 
Med J Armed Forces India. 2004 January; 60(1): 96.
Published online 2011 July 21. doi:  10.1016/S0377-1237(04)80188-6
PMCID: PMC4923489

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

Dear Editor,

I read with interest the article on “aggressiveness - the key to a successful outcome in necrotizing soft tissue infection” published in MJAFI 2003;59:21-4 and I congratulate the authors for stressing on the need of aggressiveness in the management of this dreaded disease. They should also be appreciated that they had only 20% mortality in their study of this life threatening condition while literature says that the mortality is very high ranging, from 22-60% [1]. I would like to add two practical points in the management of this condition (a) In cases where there is involvement of the perineum and scrotum, it is always better to do a diverting colostomy to avoid the contamination of a debrided wound and to expedite the healing. The authors have not mentioned whether in their 5 cases of perineal and scrotal involvement they resorted to diversion or not. (b) In this condition due to toxaemia, there is always severe haemolysis, anaemia and patient is usually in immuno-compromised status. In such patients the repeated blood transfusions along with broad spectrum antibiotics help in improving the general condition of the patient [2]. If available, Clindamycin has superior efficacy in streptococcal and clostridial necrotizing fascitis. This is also the drug of choice for the primary treatment of the entity in the dosage of 600-900 mg IV 6 to 8 hourly in combination with high doses of ampicillin plus ciprofloxacin. The IV metronidazole is an alternative treatment only [3]. However, antibiotic treatment is only a useful adjunct while aggressive surgery (drainage and debridement) is a life saving tool.

References

1. Ben-Aharon U, Borenstein A, Eisenkraft S, Lifschitz O, Leviav A. Extensive soft tissue infection of the perineum. Isr J Med Sci. 1996;32:745–749. [PubMed]
2. Harjai MM. Necrotizing fascitis (letter) MJAFI. 2000;56:273–274.
3. Stevens DL. Infections of the skin, muscle and soft tissues. In: Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Harrison's Principles of Internal Medicine. 15th ed. McGraw-Hill Medical Publishing Division; New York: 2001. pp. 821–825.

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