Necrotizing Fasciitis and Diabetic Foot: Results of a Prompt Identification, Surgery and Antibiotic Therapy (P.I.S.A.) Protocol

Autor:	Paolo Malacarne, Irene Lorenzi, Luisa Baroni, Alberto Piaggesi, Letizia Pieruzzi, Chiara Goretti, Elisabetta Iacopi, Catia Sbarbaro
Rok vydání:	2021
Předmět:	medicine.medical_specialty business.industry medicine.medical_treatment Soft tissue General Medicine Fascia medicine.disease Diabetic foot Surgery medicine.anatomical_structure Amputation Diabetes mellitus Antibiotic therapy medicine Fasciitis business Limb loss
Zdroj:	The International Journal of Lower Extremity Wounds. :153473462110414
ISSN:	1552-6941 1534-7346
Popis:	Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening infection, involving the skin, soft tissue and fascia. We evaluated outcomes of its surgical management in diabetic foot (DF) patients in a tertiary referral centre. We retrospectively searched for NF in the database of our DF Section from 2016 to 2018. All cases were treated according to a multiprofessional integrated protocol, with Prompt Identification, Surgical debridement and systemic Antibiotic therapy (P.I.S.A. Protocol). We analysed short-term evolution (surgical procedures and major amputations), and long-term outcomes (survival and healing rates). Sixty-eight patients were referred to our DF clinic for suspicion of NF. The diagnosis was confirmed in 54 (79.4%; male/female 40/14; type 1/2 diabetes 6/48; age 62.8 ± 8.1 years; duration of diabetes 13.6 ± 10.1 years). According to the microbiological results, cases were classified as Type 1 (33–61.2%), 2 (7−12.9%) and 3 (14–25.9%). No significant differences were observed. All patients underwent a decompressive fasciotomy. Six patients (11.1%) required also a forefoot amputation and 12 (22.2%) a toe or ray amputation. No major amputation was performed in the short-term period. During the follow-up (26 ± 12 months) 46 patients (85%) healed in 94 ± 11 days. Of the remaining 8: 5 (9.2%) died for other reasons before healing, 2 (3.7%) recurred and one (1.9%) required a major amputation. Our experience reveals a relatively high prevalence of NF in DF; despite this, we observed how, when promptly and aggressively treated, NF has a good prognosis and it is not associated with an excess of limb loss and deaths.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::878dc6b6eca2b3b7c8b72a9515f710dc https://doi.org/10.1177/15347346211041452 Zobrazit plný text záznamu