Predisposing Factors, Management and Outcomes of Necrotizing Fasciitis at Al-Thawra Modern General Hospital, Yemen

Abstract

Background: Necrotizing fasciitis (NF) still a life-threatening condition in Yemen. Aim: The aims of this study were to identify the predisposing factors, management and outcomes of NF among Yemeni patients. Methods: A descriptive study was conducted at Al-Thawra Modern General Hospital located in Sana’a, Yemen. All medical records of patients with confirmed NF admitted to the Surgery Department between January 2020 and January 2021 were reviewed. Results: The study enrolled 54 patients diagnosed with NF. Male patients were 43 (79.6%) and female patients were 11 (20.3%). The age range was 9 – 75 years old. The incidence of NF increased with age and the peak age incidence was at 46 – 60 years (33.3%). Similarly, the incidence of NF increased with male gander (79.6%), in comorbid patients (64.8%) especially diabetic mellitus (DM) (37%). The etiologies of NF were trauma (16.7%) and perianal abscess (14.8%). However, 27.8% of NF patients didn’t have specific cause. Most involving areas were lower limb (53.5%) followed by perineum (14.4%). The defected wound after complete debridement treated by skin graft in (32.5%) and primary closure in (27.5%). The mortality rate was 27.7% (n = 15); 60% (n = 9) of them died on the first five days. The most reason of death was septic shock (73.2%). The mortality rate was 66.6% among male compared to 33.3% among female. The higher mortality rate was reported among patients who presented in shocked/toxic (73.3%), comorbid patients (73.3%), bedridden and restricted patients (66.6%), rural patients (66.6%) and patients aged > 60 years (46.6%). Conclusion: NF still represents a life-threatening condition with challenges in diagnosis. Incidence and mortality rate of NF are common in male gander, an elderly patient, or in who suffers of comorbidities; especially DM.