Effectiveness of Single-Stage Aggressive Debridement Compared to Multi-Stage Surgery in Necrotizing Fasciitis

Abstract

Abstract

Background:
Necrotizing fasciitis is a rapidly progressive, life-threatening soft tissue infection requiring prompt surgical intervention.

Objective:
To compare clinical outcomes between single-stage and multi-stage surgical management in patients with necrotizing fasciitis.

Methodology:
Between January 2021 and December 2022, a prospective observational research was carried out at Shifa College of Nursing, STMU, Islamabad. Ninety-six patients with necrotizing fasciitis were recruited and split into two groups: Group B (n=48) had multi-stage debridement, whereas Group A (n=48) received single-stage aggressive debridement. Results, such as the number of debridements, length of hospital stay, wound healing, postoperative complications, and mortality, were evaluated at discharge and 30-day follow-up. Demographic, clinical, laboratory, and radiological data were also gathered. Chi-square and independent t-tests were used for statistical analysis; p < 0.05 was deemed significant.

Results:
Both groups were comparable in baseline characteristics, including mean age (45.32 ± 12.45 vs. 46.78 ± 11.89 years), gender distribution (male: 62.50% vs. 58.33%), and comorbidities such as diabetes mellitus (45.83% vs. 50.00%). The single-stage group required significantly fewer debridements (1.00 ± 0.00 vs. 2.58 ± 0.73; p < 0.001) and had shorter hospital stays (12.45 ± 4.32 vs. 18.67 ± 5.21 days; p < 0.001). Wound healing at 30 days was achieved in 42 patients (87.50%) in the single-stage group and 40 patients (83.33%) in the multi-stage group. Postoperative complications occurred in 10 (20.83%) vs. 16 patients (33.33%), and mortality was observed in 2 (4.17%) vs. 4 patients (8.33%), with differences not statistically significant.

Conclusion:
Single-stage debridement reduces surgical interventions and hospital stay without compromising short-term outcomes compared to multi-stage management.