INTRA-OPERATIVE SIGNS AND PRINCIPLES OF SURGICAL DEBRIDEMENT FOR NECROTIZING FASCIITIS

Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening soft-tissue infection marked by extensive necrosis of fascia, subcutaneous fat, and adjacent structures, accompanied by severe systemic toxicity.Aim of the study. To systematize the intra-operative signs of NF, formulate the core principles of surgical intervention, and define criteria for effective versus ineffective debridement.Materials and methods. The analysis is based on 150 NF cases treated between 1999 and 2024 in surgical units that serve as clinical bases of Danylo Halytsky Lviv National Medical University.Results and discussion. Five key intra-operative features were identified: absence of bleeding, presence of necrotic tissue, foul-smelling “dish-water” pus, gas in the tissues, and effortless blunt dissection. These findings are decisive for confirming the diagnosis and determining the surgical extent. An algorithmic four-stage protocol was developed: (1) Surgical exposure, (2) Intra-operative verification of NF, (3) Excisional stage – mapping and radical removal of infected tissue, and (4) Final stage – haemostasis, irrigation of wound cavities, and loose drainage. Implementation of this standardized sequence reduced mortality when surgery was performed within the first 6 hours of admission (12 % vs 29 %).Conclusions. Necrotizing fasciitis is a severe, poly-etiological disease that often presents insidiously. Clear, sequenced surgical actions are essential to ensure adequate diagnosis and treatment. Applying the algorithmic protocol lowered overall mortality from 29.0 % to 12.0 %.