J Korean Orthop Assoc.  2007 Oct;42(5):636-643. 10.4055/jkoa.2007.42.5.636.

Type I, II Acute Necrotizing Fasciitis of the Low Extremity

• Song SJ
• Lee IS
• Chung JH

• KMID: 2186471
• DOI: http://doi.org/10.4055/jkoa.2007.42.5.636

Abstract

PURPOSE: To retrospectively analyze the clinical presentations, radiographic findings, and surgical results of type I and II acute necrotizing fasciitis of the low extremity.
MATERIALS AND METHODS
From April 1998 to March 2005, 13 patients who underwent surgery for the necrotizing fasciitis were reviewed. At the initial diagnosis, 6 patients were diagnosed with cellulitis and 3 patients were diagnosed correctly with necrotizing fasciitis. The underlying diseases, affected sites, official readings of MRI, the intervals between the onset of symptom and surgery, the duration of admission, and complications were investigated.
RESULTS
The underlying diseases were 3 cases of diabetes, 3 cases of liver disease, 1 case of alcoholism and 1 case of cervical cancer with chemotherapy. Regarding the location of the disease, 5 cases were observed below the knees, and 8 cases were observed above the knees. Five out of 9 cases who underwent a preoperative MRI study, were diagnosed correctly as necrotizing fasciitis by the radiologist. The average period between onset of symptoms and surgery was 4.8 days. The complications were hip disarticulation in 1 case, below knee amputation in 1 case, toe amputation in 1 case, and a limited range of motion of the knee joint in 1 case. The 9 patients who healed without complications had no limitation in the range of joint motion and daily activity.
CONCLUSION
Type I and II acute necrotizing fasciitis of the low extremity shows variable clinical presentations and radiological findings. Therefore, the possibility of the necrotizing fasciitis needs to be considered when dealing with patients with soft tissue infections in the low extremities.

Keyword

Low extremity; Necrotizing fasciitis

MeSH Terms

Alcoholism
Amputation
Cellulitis
Diagnosis
Disarticulation
Drug Therapy
Extremities*
Fasciitis, Necrotizing*
Hip
Humans
Joints
Knee
Knee Joint
Liver Diseases
Magnetic Resonance Imaging
Range of Motion, Articular
Reading
Retrospective Studies
Soft Tissue Infections
Toes
Uterine Cervical Neoplasms

Figure

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  Fig. 1 The clinical photography of necrotizing fasciitis that developed on both low extremities show erythema, diffuse swelling and dusky skin color changes (arrow). The patient had rapid progression of the infection with migration of the margins of erythema and skin induration from the foot to thigh before surgery. The region of dusky skin color change (arrow) on the foot finally became necrotic and required a skin graft.

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  Fig. 2 Plain X-ray anteroposterior and lateral images of the left tibia show diffuse soft tissue edema with gas (arrow) lying on the fascia.

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  Fig. 3 T2-weighted axial and coronal MR images show diffuse edematous changes in the superficial and deep fascia and gas along the posteromedial aspect of the thigh.

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  Fig. 4 A 60-year old female had a hysterectomy 2 years ago, and was hospitalized with right leg pain, edema and fever. In the MRI images, necrotizing fasciitis was suspected by the radiologist but her illeness was clinically diagnosed as a unilateral leg lymphedema after the hysterectomy. She was spontaneously restored after conservative treatment.

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