Factors affecting the mortality of necrotizing fasciitis involving the upper extremities

Surg Today. 2008;38(12):1108-13. doi: 10.1007/s00595-008-3799-2. Epub 2008 Nov 28.


Purpose: Necrotizing fasciitis involving the upper extremities is an uncommon, but potentially life-threatening infection. Surgical records were reviewed to identify its mortality risk factors.

Methods: A 10-year retrospective review was conducted of all patients with upper limb necrotizing fasciitis treated in a tertiary care hospital in northern Taiwan. The demographic data, physical and laboratory findings and salient information with respect to the treatment and clinical outcome were collected and analyzed.

Results: Fourteen patients were identified. The mean age of the all-male cohort was 60.2 years (range, 44-83 years). Five of the patients died, yielding a mortality rate of 35.7%. At the time of presentation, all 14 patients had pain and swelling, but fever occurred in only 7 patients. Associated chronic debilitating diseases, of which diabetes mellitus was the most common, were present in 9 individuals. Patients underwent an average of two surgical debridements. The initial presentation in a state of altered consciousness or respiratory distress was found to be a statistically significant factors for eventual mortality (P < 0.05).

Conclusion: The results showed that necrotizing fasciitis of the upper extremity is associated with a high mortality rate. Early diagnosis and referral for aggressive surgical treatment before the development of systemic toxic signs are therefore considered to be essential for survival.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Comorbidity
  • Debridement
  • Diabetes Mellitus / epidemiology
  • Fasciitis, Necrotizing / epidemiology
  • Fasciitis, Necrotizing / mortality*
  • Humans
  • Male
  • Middle Aged
  • Risk Factors
  • Skin Transplantation
  • Taiwan / epidemiology
  • Upper Extremity*