Abstract

Objective

To improve diagnostic and surgical outcomes in patients with necrotizing soft tissue infections (NSTIs).
 

Materials and Methods

Sixty-eight patients with NSTIs admitted to the surgical department of City Medical Center No. 3 in Dushanbe were analyzed. Males accounted for 32 (47.1%), females for 36 (52.9%); age ranged from 30 to 84 years. Necrotizing erysipelas was diagnosed in 27 (39.7%) patients, necrotizing fasciitis in 31 (45.6%), and myonecrosis in 10 (14.7%). Diagnosis included clinical examination, laboratory and instrumental methods, bacteriological analysis of wound material, regional hemodynamics assessment, and transcutaneous oxygen tension measurement. 
 

Results

In necrotizing fasciitis and myonecrosis, early clinical presentation lacked pathognomonic signs despite severe systemic inflammatory response. In 21 patients, absence of pus on puncture and ultrasound was misinterpreted as serous inflammation, delaying surgical intervention. With increasing depth of tissue involvement, CRP, procalcitonin, creatine kinase, lactate dehydrogenase, D-dimer, and ferritin rose significantly. Microbial associations were found in 42 (61.8%) patients; mixed aerobic-anaerobic infection in 31 (45.6%). Split-thickness skin grafting was performed in 16 (23.5%) patients; complete graft take was achieved in 12 (75.0%). High-level amputation was required in 13 (19.1%) patients. Overall mortality was 23.5% (16/68).
 

Conclusion

NSTIs are characterized by rapid progression, diagnostic difficulty, severe systemic inflammation, and high mortality. Absence of pus should not preclude surgical exploration. Key treatment components include early diagnostic revision, radical necrectomy, staged surgical debridements, rational antibiotic therapy, and wound bed preparation for reconstructive closure.
 

Keywords

necrotizing soft tissue infection; necrotizing fasciitis; myonecrosis; lipid peroxidation; procalcitonin; skin grafting.

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