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Necrotizing Fasciitis in a Patient with Type 2 Diabetes Mellitus

David M. Kanuck, DPM ^*, Thomas Zgonis, DPM  and Gary Peter Jolly, DPM ^*

^* Center for Reconstructive Foot Surgery, PC, Plainville, CT.
Department of Orthopaedics, The University of Texas Health Science Center at San Antonio, San Antonio.

Corresponding author: Thomas Zgonis, DPM, Department of Orthopaedics, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MCS 7776, San Antonio, TX 78229.

Abstract

Necrotizing fasciitis is a soft-tissue infection characterized by extensive necrosis of subcutaneous fat, neurovascular structures, and fascia. In general, fascial necrosis precedes muscle and skin involvement, hence its namesake. Initially, this uncommon and rapidly progressive disease process can present as a form of cellulitis or superficial abscess. However, the high morbidity and mortality rates associated with necrotizing fasciitis suggest a more serious, ominous condition. A delay in diagnosis can result in progressive advancement highlighted by widespread infection, multiple-organ involvement, and, ultimately, death. We present a case of limb salvage in a 52-year-old patient with type 2 diabetes mellitus and progressive fascial necrosis. A detailed review of the literature is presented, and current treatment modalities are described. Aggressive surgical debridement, comprehensive medical management of the sepsis and comorbidities, and timely closure of the resultant wound or wounds are essential for a successful outcome. (J Am Podiatr Med Assoc 96(1): 67–72, 2006)

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