Tuesday, February 14, 2017

What is Necrotizing Fasciitis?



Necrotizing fasciitis is a catastrophic infection problem that can lead to amputation or death. Necrotizing fasciitis will have a better outcome if it is recognized early and treated successfully. It presents itself as a cellulitis case and confused health care professionals.


Necrotizing fasciitis can spread rapidly and the condition of the patient can deteriorate, even though the patient is in the hospital under the care of physicians. By the time the physician figures it out, it may be too late!

A small incision can be made over the involved area in the clinic or the emergency room, with direct inspection of the fascia and the muscles. This may differentiate between necrotizing fasciitis and cellulitis.

A culture is usually obtained to determine the species of bacteria present within the wound. The gram stain may show gram-positive cocci in chains or polymicrobial.



Necrotizing fasciitis, commonly known as flesh-eating disease, is a limb and life threatening soft tissue infection. The bacteria produces toxins and spreads rapidly. There is also an association between hepatitis C and necrotizing fasciitis. Early diagnosis and adequate treatment is important to save the limb or the life. It usually occurs after a minor trauma and may be associated with chronic disease and illness. It is usually found in alcoholics, diabetics, insect bites, or post-surgical infections.

The mortality rate is 33%. It is underdiagnosed because it resembles low grade cellulitis. Surgical debridement should be performed urgently. A delay in surgery of more than 24 hours is associated with an increased mortality rate.

A diagnosis is made when the patient has pain and tenderness beyond the apparent margin of infection, this is found in 98% of cases. Other diagnostic symptoms include erythema, bullae formation, crepitus, skin necrosis, tachycardia, fever, and low blood pressure (hypotension).



An early diagnosis is important and should include aggressive and extensive debridement of the affected area. The physician should obtain a biopsy from the periphery. Debridement should be repeated on an almost daily basis. The patient will be prescribed antibiotics (according to the culture results) and hyperbaric oxygen (good results for clostridial myonecrosis). There is a high incidence of extremity amputation if the fascia is penetrated by the infection.