The Outcomes of Management of Necrotizing Soft Tissue- Infections in Lower Limbs of Diabetic Patients

• Hasan I. Fadel Saad

  Department of Surgery, Faculty of Medicine, Omar Al Mukhtar University, El Bayda, Libya

  Author

• Tawfik Abuzalout

  Department of Surgery, Faculty of Medicine, Benghazi University, Libya

  Author

• Naser Musbah

  Department of Surgery, Faculty of Medicine, Omar Al Mukhtar University, El Bayda, Libya

  Author

• Ahmed Farag

  Department of Surgery, Faculty of Medicine, Omar Al Mukhtar University, El Bayda, Libya

  Author

Necrotizing soft tissue infection (NSTI) of the lower limb in diabetic patients (pts) is a common serious problem and is often associated with serious complications such as increased morbidity and mortality. The study aimed to assess 3 years (yrs) experience of NSTI and to review treatment and outcome in diabetic pts at Al Thoura Teaching Hospital between May 1^ST 2014 –30^th April 2017, over a period of 3 yrs.24 cases of NSTI of lower limbs in diabetic pts were admittedin the period of MAY 1^ST 2014 –30^th April 2017. Assessment and analyzing details about their presentation, clinical features, predisposing factors, treatment offered, and outcomes were performed .16 male and 8 female pts with a mean age of 56.4 yrs (range of 39- 78 yrs) were included . Majority of patients were in the age group of 50 to 70 yrs. The most important risk factors were (glycosylated HbA1c > 9.5% in 91.66%), smoking (58.33%), hypertension and hyperlipidemia (66.66% & 83.33% respectively). Neuropathy was found in 62.5% and PVD in 50%. The total involved feet are 27. The port of infection was mostly by previous unhealed feet ulcer 48.1%. The most operated surgical procedure is aggressive frequent necrectomy (51%). Multiple toes amputations and extended tarsal amputation were needed in 29.6% and 20.8% respectively. The need for grafting, flap advancement after surgical control of infection was needed in 6 cases. The failure rate of conservative surgery was 11.11%. Complete healing was in 70.37% of cases. The morbidity rate was high in all patients in this study 92.59%. The mortality rate was 3.7%. We conclude that NSTI of lower limbs is a life-threatening infective condition, common among diabetic patients, and early diagnosis with immediate and frequent surgical debridement could reduce systemic complications, morbidity, and mortality considerably.

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