The aim of this study was to analyze the outcomes of treatment of necrotizing
soft-tissue infections (NSTIs) in the feet of diabetic patients and to determine factors associated with
limb salvage and mortality. A retrospective study of a consecutive series of 145 diabetic patients suffering from NSTIs treated in the
Diabetic Foot Unit, La Paloma Hospital was done. NSTIs were classified as necrotizing
cellulitis if it involved the subcutaneous tissue and the skin, as
necrotizing fasciitis if it involved the deep fascia, and as myonecrosis in those cases where muscular
necrosis was present. In the necrotizing
cellulitis group (n = 109), 8 (7.3%) major
amputations were performed. In the
necrotizing fasciitis group (n = 25), 13 (52%) major
amputations were undertaken. In the myonecrosis group (n = 11), 6 (54.5%) major
amputations were performed. Predictive variables related to limb loss were
fasciitis (OR = 20, 95% CI = 3.2-122.1) and myonecrosis (OR = 53.2, 95% CI = 5.1-552.4). Predictive variables of mortality were age >75 years (OR = 10.3, 95% CI = 1.9-53.6) and
creatinine values >132.6 micromol/L (OR = 5.8, 95% CI = 1.1-30.2). NSTIs of the foot are an important cause of morbidity and mortality in diabetic patients.When fascia and/or muscle are involved, there are significant risks of major
amputation.