Necrotizing Soft Tissue Infections.

e initial terminology used to describe 2,642 cases of necrotizing infections as "hospital gangrene" was coined by Dr. Joseph Jones, surgeon of the Confederate Army in 1871 [1]. Later in 1883, Dr. Jean- Alfred Fournier characterized necrotizing infections to the perineum. Necrotizing fasciitis was initially described and named "hemolytic streptococcal gangrene" by Meleney in 1924 [2]. He described an illness characterized by gangrene of subcutaneous tissues, followed by rapid necrosis of the overlying skin from involvement of the blood vessels supplying the skin, which are found in the affected fascial layers. All his patients grew hemolytic streptococci on cultures, and the patients were all seriously ill. Surgical extirpation appeared to be the best therapeutic approach then and remains so. The actual term Necrotizing Fasciitis was credited to Dr. Wilson much later in 1952 [3]. Media often refers to this entity as infection with «Flesh-eating bacteria."The annual incidence of NSTI varies considerably but is often reported at approximately four per 100,000 in developed countries [4]. Mortality rates highlight the severity of disease with a 90-day mortality of 18% reported in a multi-center study including more than 400 patients [5].