Necrotizing fasciitis

Necrotizing fasciitis

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Necrotizing fasciitis

This is an acute invasive infection of the subcutaneous tissue and fascia characterized by vascular thrombosis, which leads to tissue necrosis. The skin is secondarily affected. It is idiopathic in origin but minor wounds, ulcers and surgical wounds are believed to be initiating factors. The condition is described as “Meleney’s synergistic gangrene” if it occurs over the abdominal wall and “Fournier’s gangrene “if in the scrotum and perineal area.

Mixed pathogens of the following microorganisms are usually cultured.

  • Streptococci
  • Staphylococci
  • Gram negative bacteria
  • Anaerobes and
  • Clostridia

Clinical Features

  • Sudden onset of localized pain
  • Rapidly spreading inflammation
  • Spread along chemic fascial planes
  • Hemorrhagic bulla and edema
  • Skin devascularization
  • +/- Crepitations
  • +/- Muscle necrosis
  • Systemic signs of toxemia

Management

  • Broad spectrum combined antibiotics
  • Gentamycin or Ceftriaxone for coverage of aerobic organisms and
  • Cloxacilline or chloramphenicol or Metronidazole for coverage of anaerobic organisms
  • Circulatory support with intravenous fluid as much as required and transfusion of cross matched blood when necessary
  • Surgery soon as possible
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