Endoscopic management of early necrotising fasciitis in the diabetic foot: case series and technical considerations
Gerardo Enrique Aguirre Garza, Melissa Alejandra Flores GuerreroObjective:
To describe the early endoscopic management of necrotising fasciitis (NF) in the diabetic foot and to highlight its feasibility and safety, and the potential benefits for tissue preservation when used in the initial stages of infection.
Method:
A case series of three patients with type 2 diabetes and early-stage NF treated using a minimally invasive endoscopic approach. The procedure involved exploration of dissected planes, direct visualisation of necrotic tissue, irrigation with polyhexanide and betaine, and the application of a topical antimicrobial gel. Reinterventions were performed as indicated by disease progression. Demographic, clinical, microbiological and laboratory data from the cases were analysed.
Results:
Two patients presented with an initial Laboratory Risk Indicator for Necrotising Fasciitis score of 7, while another patient scored 9, where ≥6 indicates NF. Infection control was achieved within 5–7 days with no major amputations. One patient required minor amputation of the third toe, while another required conversion to open surgery due to pain. Functional preservation was achieved in all of the cases, and only one patient required a two-day hospital stay. No endoscopy-related complications occurred.
Conclusion:
Early endoscopic intervention may be a feasible and safe alternative for selected patients with diabetic foot NF in its initial phase. This approach allows prompt infection control, tissue preservation and potentially shorter hospital stays compared to conventional open surgery. Further comparative studies are warranted to validate these findings.