{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T16:32:39Z","timestamp":1789749159305,"version":"4.0.1"},"reference-count":33,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2021,9,7]],"date-time":"2021-09-07T00:00:00Z","timestamp":1630972800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The International Journal of Lower Extremity Wounds"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:p>Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening infection, involving the skin, soft tissue and fascia. We evaluated outcomes of its surgical management in diabetic foot (DF) patients in a tertiary referral centre. We retrospectively searched for NF in the database of our DF Section from 2016 to 2018. All cases were treated according to a multiprofessional integrated protocol, with Prompt Identification, Surgical debridement and systemic Antibiotic therapy (P.I.S.A. Protocol). We analysed short-term evolution (surgical procedures and major amputations), and long-term outcomes (survival and healing rates). Sixty-eight patients were referred to our DF clinic for suspicion of NF. The diagnosis was confirmed in 54 (79.4%; male\/female 40\/14; type 1\/2 diabetes 6\/48; age 62.8\u2009\u00b1\u20098.1 years; duration of diabetes 13.6\u2009\u00b1\u200910.1 years). According to the microbiological results, cases were classified as Type 1 (33\u201361.2%), 2 (7\u221212.9%) and 3 (14\u201325.9%). No significant differences were observed. All patients underwent a decompressive fasciotomy. Six patients (11.1%) required also a forefoot amputation and 12 (22.2%) a toe or ray amputation. No major amputation was performed in the short-term period. During the follow-up (26\u2009\u00b1\u200912\u2005months) 46 patients (85%) healed in 94\u2009\u00b1\u200911 days. Of the remaining 8: 5 (9.2%) died for other reasons before healing, 2 (3.7%) recurred and one (1.9%) required a major amputation. Our experience reveals a relatively high prevalence of NF in DF; despite this, we observed how, when promptly and aggressively treated, NF has a good prognosis and it is not associated with an excess of limb loss and deaths.<\/jats:p>","DOI":"10.1177\/15347346211041452","type":"journal-article","created":{"date-parts":[[2021,9,7]],"date-time":"2021-09-07T03:58:40Z","timestamp":1630987120000},"page":"733-741","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Necrotizing Fasciitis and Diabetic Foot: Results of a Prompt Identification, Surgery and Antibiotic Therapy (P.I.S.A.) Protocol"],"prefix":"10.1177","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9007-9378","authenticated-orcid":false,"given":"Elisabetta","family":"Iacopi","sequence":"first","affiliation":[{"name":"Diabetic Foot Section, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catia","family":"Sbarbaro","sequence":"additional","affiliation":[{"name":"First service of Anaesthesia and Critical Care Medicine -Pisa University Hospital, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Letizia","family":"Pieruzzi","sequence":"additional","affiliation":[{"name":"Diabetic Foot Section, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Lorenzi","sequence":"additional","affiliation":[{"name":"First service of Anaesthesia and Critical Care Medicine -Pisa University Hospital, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luisa","family":"Baroni","sequence":"additional","affiliation":[{"name":"First service of Anaesthesia and Critical Care Medicine -Pisa University Hospital, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Goretti","sequence":"additional","affiliation":[{"name":"Diabetic Foot Section, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Malacarne","sequence":"additional","affiliation":[{"name":"First service of Anaesthesia and Critical Care Medicine -Pisa University Hospital, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8704-561X","authenticated-orcid":false,"given":"Alberto","family":"Piaggesi","sequence":"additional","affiliation":[{"name":"Diabetic Foot Section, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,9,7]]},"reference":[{"key":"bibr1-15347346211041452","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa042683"},{"key":"bibr2-15347346211041452","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2014.00036"},{"key":"bibr3-15347346211041452","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.9371"},{"key":"bibr4-15347346211041452","first-page":"40","volume":"23","author":"Roje Z","year":"2011","journal-title":"World J Emerg Surg"},{"key":"bibr5-15347346211041452","doi-asserted-by":"publisher","DOI":"10.1159\/000339161"},{"key":"bibr6-15347346211041452","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-200005000-00002"},{"key":"bibr7-15347346211041452","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199601253340407"},{"key":"bibr8-15347346211041452","doi-asserted-by":"publisher","DOI":"10.1097\/00001432-200104000-00003"},{"key":"bibr9-15347346211041452","first-page":"37","volume":"53","author":"Di Nubile MJ","year":"2004","journal-title":"J Antimicrob Chemother"},{"key":"bibr10-15347346211041452","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-199711000-00001"},{"key":"bibr11-15347346211041452","doi-asserted-by":"publisher","DOI":"10.1016\/S0021-7697(07)91959-6"},{"key":"bibr12-15347346211041452","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2004.03.022"},{"key":"bibr13-15347346211041452","doi-asserted-by":"publisher","DOI":"10.1016\/j.asjsur.2012.04.006"},{"key":"bibr14-15347346211041452","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.49.2964"},{"key":"bibr15-15347346211041452","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-199202000-00011"},{"key":"bibr16-15347346211041452","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-199505000-00013"},{"key":"bibr17-15347346211041452","doi-asserted-by":"publisher","DOI":"10.1002\/9781444315172.ch20"},{"key":"bibr18-15347346211041452","doi-asserted-by":"publisher","DOI":"10.1177\/1534734615606534"},{"key":"bibr19-15347346211041452","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000004302"},{"key":"bibr20-15347346211041452","doi-asserted-by":"publisher","DOI":"10.1007\/s10286-017-0485-8"},{"key":"bibr21-15347346211041452","doi-asserted-by":"publisher","DOI":"10.1111\/anae.14347"},{"key":"bibr22-15347346211041452","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2020.108355"},{"key":"bibr23-15347346211041452","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(94)90129-5"},{"key":"bibr24-15347346211041452","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000170199.43624.B8"},{"issue":"6","key":"bibr25-15347346211041452","first-page":"18","volume":"64","author":"Gruppo studio SIAARTI per la sicurezza in Anestesia e Terapia Intensiva.","year":"1998","journal-title":"Minerva Anestesiol Giugno"},{"key":"bibr26-15347346211041452","doi-asserted-by":"publisher","DOI":"10.1177\/1534734609344106"},{"key":"bibr27-15347346211041452","doi-asserted-by":"publisher","DOI":"10.1177\/107110070602700806"},{"key":"bibr28-15347346211041452","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(97)00160-5"},{"key":"bibr29-15347346211041452","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000001957"},{"key":"bibr30-15347346211041452","doi-asserted-by":"publisher","DOI":"10.1177\/1534734620943021."},{"key":"bibr31-15347346211041452","doi-asserted-by":"publisher","DOI":"10.4103\/ija.IJA_296_19"},{"key":"bibr32-15347346211041452","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2009.04.009"},{"key":"bibr33-15347346211041452","doi-asserted-by":"publisher","DOI":"10.4097\/kjae.2015.68.5.513"}],"container-title":["The International Journal of Lower Extremity Wounds"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15347346211041452","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15347346211041452","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15347346211041452","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T10:04:48Z","timestamp":1777457088000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15347346211041452"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,7]]},"references-count":33,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,12]]}},"alternative-id":["10.1177\/15347346211041452"],"URL":"https:\/\/doi.org\/10.1177\/15347346211041452","relation":{},"ISSN":["1534-7346","1552-6941"],"issn-type":[{"value":"1534-7346","type":"print"},{"value":"1552-6941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,7]]}}}