Limb Salvage for Streptococcal Gangrene of the Extremity

Background: Extremity soft tissue infections from group A, β-hemolytic streptococcus frequently culminate in amputation. This study compares our protocol for limb salvage with expected results. Methods: Patients with extremity streptococcal gangrene treated from 1989 to 1995 were reviewed. The management protocol mandated immediate, radical excision of involved skin and subcutaneous tissue, with preservation of fascia. Patients were managed in the burn unit, and wounds were covered with split-thickness skin grafts. Amputation rate and mortality were measured. Results: Fourteen cases of extremity streptococcal gangrene were identified. Delay to surgical referral was 5 days. Eleven (79%) patients were septic. Ten (71%) were managed with a single debridement before grafting. Limb salvage was 93% (13 of 14). One patient (7%) died on day 150 from acute myelogenous leukemia. Conclusions: Delay in referral of extremity streptococcal gangrene is common, contributing to a high incidence of sepsis. Our management protocol of a single, radical debridement with preservation of fascia maximizes limb salvage and survival.