Burn center management of necrotizing soft-tissue surgical infections in unburned patients

• Published in: The American journal of surgery 2001-12, Vol.182 (6), p.563-569
• Main Authors: Faucher, Lee D, Morris, Stephen E, Edelman, Linda S, Saffle, Jeffrey R
• Format: Article
• Language: English
• Subjects: Body weight; Burn Units; Case series; Cost-Benefit Analysis; Debridement; Diabetes Complications; Diabetes mellitus; Fasciitis; Fasciitis, Necrotizing - economics; Fasciitis, Necrotizing - rehabilitation; Fasciitis, Necrotizing - surgery; Fasciitis, Necrotizing - therapy; Female; Fournier Gangrene - economics; Fournier Gangrene - rehabilitation; Fournier Gangrene - surgery; Fournier Gangrene - therapy; Fournier’s gangrene; Gangrene; Hospitals; Humans; Hypertension; Hypertension - complications; Length of Stay; Male; Medical referrals; Middle Aged; Mortality; Necrotizing fasciitis; Obesity - complications; Rehabilitation; Review; Skin; Streptococcus infections; Substance abuse treatment; Surgeons; Surgery; Ulcers; Wound healing
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(01)00785-1

Background: Patients with necrotizing soft-tissue infections present great challenges in management from initial presentation through definitive care. Because burn centers concentrate expertise in critical care, wound management, and rehabilitation, we examined the effectiveness of burn center care for patients with necrotizing infections. Methods: We reviewed our burn center’s experience with all patients admitted from 1990 through 1999 with a primary diagnosis of necrotizing fasciitis (NF) or Fournier’s gangrene (FG). Results: Fifty-seven patients were identified, 18 with FG and 39 with NF. Patients had a high incidence of preexisting medical problems, including diabetes (37%), obesity defined as greater than 20% above ideal body weight (33%), and hypertension (33%). Seven of 57 (12%) patients died. Patients required a mean of 4.1 operative procedures (range 1 to 15) for definitive wound closure. The mean length of stay (survivors only) was 28.5 days, (range 3 to 70). Although costs increased throughout this period, a formal program of cost-containment resulted in no increase in actual charges per day, from a mean of $4,735 in 1991 to $5,202 in 1999. Conclusions: Burn centers can provide successful and cost-effective acute care, definitive wound closure, and rehabilitation for patients with NF and FG.