Necrotizing fasciitis: treatment concepts and clinical results

  • M. Leiblein
  • I. Marzi
  • A. L. Sander
  • J. H. Barker
  • F. Ebert
  • J. Frank
Original Article



Necrotizing fasciitis is a life-threatening soft tissue infection characterized by a rapid spreading infection of the subcutaneous tissue and in particular the fascia. The management of infected tissues requires a rapid diagnosis, immediate aggressive surgical management and an extended debridement. In some cases early amputations of the affected tissues and maximum intensive care treatment, in case of sepsis, are required. Due to a rising number of cases we aimed to evaluate our patients in a retrospective review.


All patients diagnosed with necrotizing fasciitis from 2014 to 2016 (21 months) in our level one trauma center were identified. Their charts were reviewed and data were analyzed in terms of demographic and social information, microbiological results, therapeutic course, socio-economic outcome and mortality.


We found 15 patients with necrotizing fasciitis. None of these died in the observation period. The mean number of surgical interventions was seven. Two patients underwent limb amputation; diabetes mellitus was assigned with a significant higher risk for amputation. The mean hospitalization was 32 days, including 8 days on intensive care unit. Of the discovered bacteria 93% were sensitive to the initial antibiotic treatment with Ampicillin, Clindamycin and Clont.


Surgical therapy is indicated if necrotizing fasciitis is suspected. Diabetes mellitus was a clinical predictor of limb amputation in patients with necrotizing fasciitis in our cohort. Aminopenicillin ± sulbactam in combination with clindamycin and/or metronidazole is recommended as initial calculated antibiotic treatment.


Necrotizing fasciitis Soft tissue infection Hemolytic streptococcal gangrene Necrotizing cellulites 


Compliance with ethical standards


There has been no source of support/funding, either pharmaceutical or industry support. No funding from any organization has been received.

Ethical approval

This retrospective study was approved by the ethic committee of the Johann Wolfgang Goethe-University Frankfurt (352/16).

Conflict of interest

Maximilian Leiblein, Ingo Marzi, Anna Lena Sander, John H. Barker, Federico Ebert and Johannes Frank declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • M. Leiblein
    • 1
  • I. Marzi
    • 1
  • A. L. Sander
    • 1
  • J. H. Barker
    • 2
  • F. Ebert
    • 1
  • J. Frank
    • 1
  1. 1.Department of Trauma, Hand, and Reconstructive SurgeryJohann Wolfgang Goethe-UniversityFrankfurt am MainGermany
  2. 2.Experimental Trauma and Orthopedic Surgery, Frankfurt Initiative for Regenerative MedicineGoethe-Universität, Friedrichsheim gGmbHFrankfurt/MainGermany

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