Successful salvage after necrotizing fasciitis in a lower extremity with hip and knee replacement

摘要

INTRODUCTION: Necrotizing fasciitis is a life-threatening soft-tissue infection, mainly involving the subcutaneous tissue and the fascia, which spreads rapidly and aggressively. The prognosis of this fulminant disease depends on its accurate diagnosis and immediate appropriate treatment. The mortality has been reported to be about 34% (range, 6% to 76%). Wong et al. reported 89 patients and noted that a delay of more than 24 hours from admission to surgery significantly increased the mortality. A review of the literature has suggested that there are only three reported cases of necrotizing fasciitis complicated by implant arthroplasties. In patients with implants and necrotizing fasciitis, amputation may be considered; however, we believe that the presence of a total joint does not mean amputation will be necessary. We report necrotizing fasciitis in a 40-year-old woman with rheumatoid arthritis and previous hip and knee arthroplasties.