Clinical outcomes of perianal necrotizing fasciitis treated by skin classification : A retrospective single center study

Background The extent of debridement in perianal necrotizing fasciitis (PNF) has not been standardized, although skin-preserving debridement is increasingly used clinically. Methods The present study retrospectively analyzed the clinical data of 102 patients with PNF treated between December 2022 and February 2025 at Shenyang Coloproctology Hospital. The skin changes associated with PNF were classified into zones. All treatment effects were observed. Results A total of 102 patients underwent debridement for PNF. Of these, 61 patients had the surgical debridement range determined based on skin zoning (SZ), while 41 patients had the surgical debridement range determined based on non-skin zoning (NSZ). There was no significant difference in the cure rate between the two groups. The length of hospital stay for patients in the SZ group was 17 days (15.00–23.00 days), while that for patients in the NSZ group was 19 days (15.00–30.50 days) (17 vs. 19, P  = 0.037). Meanwhile, the length of hospital stay was associated with LRINEC score (P = 0.034). Among the SZ group patients, 57 cases required one surgery for cure, and 3 cases required two or more surgeries for cure, while, among the NSZ group patients, 13 cases were cured with one surgery, and 28 cases required two or more surgeries for cure (13/28 vs. 57/3, P <0.001). Conclusions Determining the extent of surgical debridement based on the zoning of skin changes in PNF can reduce hospitalization time and the number of surgeries, making it an effective approach for treating PNF.