• Peter Clark, Darin Davidson, Mervyn Letts, Lou Lawton, and Ayman Jawadi.
• Division of Orthopaedics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa Ont.
• Can J Surg. 2003 Feb 1; 46 (1): 9-14.

BackgroundNecrotizing fasciitis is an uncommon but serious complication of chickenpox infection in young children. Because many of these infections affect the musculoskeletal tissues, orthopedic surgeons are often the first caregivers to be involved in diagnosis and treatment. Our objective was to review the diagnostic features of necrotizing fasciitis and analyze treatment methods to control and eradicate the musculoskeletal infection.DesignA review.SettingThe Children's Hospital of Eastern Ontario, Ottawa, a major Canadian pediatric trauma and referral centre.PatientsFive children who presented with necrotizing fasciitis secondary to chickenpox infection.InterventionSurgical debridement of the involved area of necrotizing fasciitis and intravenous antibiotic treatment with clindamycin and penicillin.Main Outcome MeasuresComplications outcome.ResultsThe average age of the 5 children at presentation was 3.8 years (range from 2.9-5.8 yr). The necrotizing fasciitis involved the lower extremity in 5 children, the upper extremity in 3, and the abdomen, chest, neck and back in 1 child each. One child presented with involvement of all 4 extremities. In 4 children, culture specimens grew group A beta-hemolytic Streptococcus. They all survived and all limbs were salvaged, although secondary closure and skin grafting were required. At an average follow-up of 1 year, each child had fully recovered with no loss of muscle function.ConclusionsNecrotizing fasciitis should be suspected in any child with a history of varicella infection and an increasing complaint of pain and swelling in an extremity or other body area associated with increasing fever, erythema, lethargy and irritability. Emergent surgical debridement and intensive antibiotic therapy are essential to prevent muscle necrosis, major limb dysfunction and death.

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