Introduction: We carried out a revision of Necrotizing Fasciitis diagnosed in our Hospital from January 2000 to July 2008. Necrotizing Fasciitis is an infection of soft tissues, caused in most of cases by Streptococcus pyogenes. It is a dangerous infection, because it progresses quickly, and it can lead to death due to systemic toxicity.

Materials and Methods: The study includes 18 patients afected by Necrotizing fasciitis treated in our Hospital from January 2000 until July 2008. In order to identify risk factors and clinical emergency signs, clinical detailed information was obtained for each patient.

Results: In 70% of the cases, Streptococcus pyogenes was found as the main germ involved in Necrotizing Fasciitis. In inicial stages, the patients complained of pain, heat, swelling, reddening and crepitation of the affected subcutaneous tissues. In advanced stages, patients went in a state of neurogenic shock. Specific antibiotical therapy was necessary in all cases. Surgical treatment was performed in 80 % of the cases, consisting of fascial aperture and debridement of devitalized tissues. In spite of the intensive medical and surgical treatments, 10% of the cases died.

Conclusion: We consider the suspicion and knowledge of Necrotizing fasciitis is crucial in order to diagnose early and properly this infection disease. Then we can be able to establish a precocious and suitable treatment which can avoid the potentially fatal outcome.

Introduction: Synovial sarcoma ranks as the fourth most common sarcoma, but it is uncommon in the hand. Most Synovial Sarcomas arise in para-articular soft tissue such as tendon, tendon sheath and bursa adjacent to the large joints capsules. Arround 60–70% of these tumors involve lower extremity and they frequently affect knee, thigh and foot. The reported incidence for Synovial Sarcoma in hand is only 8.5%.

Material and methods: We carried out a retrospective study of 6 hand and forearm sarcomas, of a series of 35 synovial sarcomas surgically treated in our center from 1991 to 1997, with a 6 years follow up (3y.–11y.). 3 patients were male and 3 female, with a mean age of 54 years at the moment of initial diagnosis. Histologically all of them were synovial sarcomas: 4 monophasic and 2 biphasic. The inmunochemistry showed that the neoplasic cells were positive for vimentin, epithelial membrane antigen and cytokeratin. 2 of them were localized in the palmar aspect of the hand (2 ulnar cases and 2 eminence tenar cases), an 2 cases were dorsal. 2 cases were misdiagnosed as benign lesions and treated with tumor excision at another center.

Results: Primary treatment consisted of radical local excision of synovial sarcoma of the hand. 5 patients received adjuvant chemotherapy with CYVADIC and radiotherapy. 2 cases of recurrence received a second surgical treatment with forearm amputation. The mean time to recurrence was 12 months. At the end of the follow-up 3 patients developed metastatic disease and 2 of them died.

Discussion: Synovial Sarcoma in hand is a highly malignant tumor; due to its morphology they can be misdiagnosed as benign lesions such as aggressive fibromatosis or ganglion cysts. If we diagnose a soft tissue tumor in hand we must practice complementary tests to achieve early diagnosis. It is also important the multidisciplinary treatment of Synovial Sarcoma.