{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T21:12:32Z","timestamp":1790284352916,"version":"4.1.0"},"reference-count":38,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,10,29]],"date-time":"2019-10-29T00:00:00Z","timestamp":1572307200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,10,29]],"date-time":"2019-10-29T00:00:00Z","timestamp":1572307200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2019,10,29]],"date-time":"2019-10-29T00:00:00Z","timestamp":1572307200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>It is unclear what the exact short\u2010term outcomes of necrotizing soft tissue infections (NSTIs), also known and necrotizing fasciitis of the upper extremity, are and whether these are comparable to other anatomical regions. Therefore, the aim of this study is to assess factors associated with mortality within 30\u2010days and amputation in patients with upper extremity NSTIs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective study over a 20\u2010year time period of all patients treated for NSTIs of the upper extremity was carried out. The primary outcomes were the 30\u2010day mortality rate and the amputation rate in patients admitted to the hospital for upper extremity NSTIs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Within 20 years, 122 patients with NSTIs of the upper extremity were identified. Thirteen patients (11%) died and 17 patients (14%) underwent amputation. Independent risk factors for mortality were an American Society of Anesthesiologists (ASA) classification of 3 or higher (OR 9.26, 95% CI 1.64\u201352.31) and a base deficit of 3\u00a0meq\/L or greater (OR 10.53, 95% CI 1.14\u201396.98). The independent risk factor for amputation was a NSTI of the non\u2010dominant arm (OR 3.78, 95% CI 1.07\u201313.35). Length of hospital stay was 15 (IQR 9\u201321) days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Upper extremity NSTIs have a relatively low mortality rate, but a relatively high amputation rate compared to studies assessing NSTIs of all anatomical regions. ASA classification and base deficit at admission predict the prognosis of patients with upper extremity NSTIs, while a NSTI of the non\u2010dominant side is a risk factor for limb loss.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-019-05256-9","type":"journal-article","created":{"date-parts":[[2019,10,30]],"date-time":"2019-10-30T20:32:25Z","timestamp":1572467545000},"page":"730-740","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Factors Associated with Mortality and Amputation Caused by Necrotizing Soft Tissue Infections of the Upper Extremity: A Retrospective Cohort Study"],"prefix":"10.1002","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8390-4483","authenticated-orcid":false,"given":"Femke","family":"Nawijn","sequence":"first","affiliation":[{"name":"Department of Surgery University Medical Center Utrecht Heidelberglaan 100 3584 CX Utrecht The Netherlands"},{"name":"Department of Orthopaedic Surgery, Hand and Upper Extremity Service Massachusetts General Hospital Boston USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svenna H.W.L.","family":"Verhiel","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hand and Upper Extremity Service Massachusetts General Hospital Boston USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiera N.","family":"Lunn","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hand and Upper Extremity Service Massachusetts General Hospital Boston USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle R.","family":"Eberlin","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Hand and Upper Extremity Service Massachusetts General Hospital Boston USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Falco","family":"Hietbrink","sequence":"additional","affiliation":[{"name":"Department of Surgery University Medical Center Utrecht Heidelberglaan 100 3584 CX Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neal C.","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hand and Upper Extremity Service Massachusetts General Hospital Boston USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,10,29]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623\u2010200308000\u201000005"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00423\u2010014\u20101162\u20101"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.15615"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco\u20102018\u2010000272"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjid.2013.08.003"},{"key":"e_1_2_9_7_1","first-page":"1","article-title":"Necrotizing fasciitis: risk factors of mortality","volume":"8","author":"Khamnuan P","year":"2015","journal-title":"Risk Manag Healthc Policy"},{"key":"e_1_2_9_8_1","first-page":"430","article-title":"Microbiology and factors affecting mortality in necrotizing fasciitis","volume":"38","author":"Liu Y","year":"2005","journal-title":"Yearb Surg"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2007.10.030"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13017\u2010016\u20100108\u2010z"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2008.112"},{"key":"e_1_2_9_12_1","unstructured":"United States Goverment.41 CFR 61\u2010250.2 \u2010 What definitions apply to this part? 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October 2019","order":1,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Dr. Eberlin\u00a0is a consultant for AxoGen and Integra. Dr. Chen received grants by Miami Device Solutions, OMeGA and Acumed. All authors declare to have no commercial relations that might pose a conflict of interest in connection with the manuscript.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was approved by the hospitals\u2019 institutional review board.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}