{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T09:53:13Z","timestamp":1791453193334,"version":"4.3.3"},"reference-count":0,"publisher":"Indian Orthopaedic Research Group","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Jocr"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:p>Introduction:\nNecrotizing fasciitis (NF) is a rapidly progressive, life-threatening soft-tissue infection characterized by extensive fascial necrosis and systemic toxicity. Reported mortality ranges from 20% to 40%, driven largely by diagnostic delay. Orthopedic units carry a disproportionate burden, particularly for lower-limb disease. This two-cycle quality improvement project (QIP) examined whether structured diagnostic pathways and early multidisciplinary escalation could reduce time to surgery and improve limb-salvage outcomes.\n\nCase Series:\nTwenty-seven patients with confirmed or suspected NF were managed across two sequential audit cycles at a tertiary orthopedic center (Cycle 1, n = 14; Cycle 2, n = 13). Mean age was 52.1 \u00b1 11.3 years; 80% had lower-limb involvement, and 70% had diabetes mellitus. Following QIP implementation, median time to surgical decision fell from 11.5 \u00b1 3.2 to 6.8 \u00b1 2.1 hours (P = 0.002). Recovery rates rose from 14.3% to 84.6% (P &lt; 0.001) and major amputation rates declined from 35.7% to 15.4% (P = 0.04). Documentation of Laboratory Risk Indicator for Necrotizing Fasciitis scores and finger-sweep testing improved significantly. In-hospital mortality remained comparable (21.4% vs. 23.1%).\n\nConclusion:\nA structured, protocol-driven approach to NF management \u2013 encompassing mandatory diagnostic documentation, early senior involvement, and multidisciplinary team activation \u2013 substantially improves surgical timeliness and limb-salvage rates. Mortality reduction may require parallel optimization of perioperative sepsis management and critical care pathways.\n\nKeywords:\nNecrotizing fasciitis , soft-tissue infection , quality improvement , LRINEC score , limb salvage , orthopedics<\/jats:p>","DOI":"10.13107\/jocr.2026.v16.i10.8348","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T09:26:46Z","timestamp":1791451606000},"page":"599-605","source":"Crossref","is-referenced-by-count":0,"title":["Early Surgical Escalation and Structured Multidisciplinary Pathways Improve Limb-Salvage Outcomes in Necrotizing Fasciitis: A Two-Cycle Quality Improvement Project"],"prefix":"10.13107","volume":"16","author":[{"given":"Aakaash","family":"Venkatesan","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, Aneurin Bevan University Health Board, Newport, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahal","family":"Baid","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Aneurin Bevan University Health Board, Newport, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar-","family":"Aldoori","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Aneurin Bevan University Health Board, Newport, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Abdalla","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Aneurin Bevan University Health Board, Newport, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"5271","published-online":{"date-parts":[[2026]]},"container-title":["Journal of Orthopaedic Case Reports"],"original-title":[],"deposited":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T09:26:47Z","timestamp":1791451607000},"score":1,"resource":{"primary":{"URL":"https:\/\/jocr.co.in\/wp\/2026\/10\/early-surgical-escalation-and-structured-multidisciplinary-pathways-improve-limb-salvage-outcomes-in-necrotizing-fasciitis-a-two-cycle-quality-improvement-project\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":0,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026]]},"published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.13107\/jocr.2026.v16.i10.8348","relation":{},"ISSN":["2321-3817"],"issn-type":[{"value":"2321-3817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]}}}