Necrotizing fasciitis – a model of an extreme condition in clinical practice

Authors:
Alisher Okhunov, Dilshod Qorikhonov, Shokhista Bobokulova

Body of Abstract:
Background. The evolutionarily developed and genetically determined protective response of the organism in the form of an urgent adaptation syndrome for the preservation of vital functions at the proper physiological level in several cases may turn out to be untenable, which puts the body on the verge of a functional breakdown, followed by irreversible disintegration of organ functions, leading to death or severe functional disorders. The resulting condition, manifested by various clinical syndromes, is called extreme for the need for practical surgery.
Methods. We analyzed the causes of death in 82 patients with necrotizing fasciitis type 2. 53 patients were male, and 29 were female. The medical history data, the features of the development and course of the disease, and the causes of death were analyzed.
Results. To the greatest extent, the concept of an extreme condition corresponded to the clinical course of necrotizing fasciitis type 2 with the development of infectious-toxic shock syndrome (100%), proceeding at lightning speed and ending in death in the first 3 days. The development of an extreme condition in the majority of patients with necrotizing fasciitis (87.8%) did not have a causal relationship with any severe underlying disease, which in itself could create a precedent of functional failure. Often, there were also no manifestations of the infectious beginning, the focus that initiates fasciitis. Microbial invasion, which was not always recorded, was usually associated with abrasions (31.7%), abrasions on the skin (24.4%) or banal wounds (18.3%), including surgical (6.1%), contusions (11%) or post-injection infiltrates and abscesses (8.5%).
Conclusions. The acute onset of the disease with the catastrophic development of severe endotoxicosis and functional disintegration form the basis of the condition, which is designated by the concept of “extreme”. At the same time, we cannot exclude the possibility of a torpid course of the disease with a prodromal period due to the accumulation of a critical concentration of the toxin in the bloodstream and the implementation of a generalized septic process, the clinical manifestations of which then become violent.