Practice development Innovations
The diagnosis and management of necrotising fasciitis
Authors:
Shady Hayek, Amir Ibrahim, Bishara Atiyeh
Necrotising fasciitis was first described more than a century ago, however, its diagnosis still represents a challenge for clinicians and the condition carries a high mortality rate. The management of necrotising fasciitis requires prompt diagnosis, early surgical excision and proper coordination between the multidisciplinary team to achieve the best outcome for the patient. This paper reviews the diagnostic tools used in identifying necrotising soft tissue infections as well as examining the microbiology, management and prognosis.
Useful links Recognising necrotising fasciitis
INTRODUCTION Necrotising soft tissue infections (NSTIs) were first described in 1871 as ‘hospital gangrene’ and they continue to carry a high mortality and morbidity rate[1]
. Necrotising soft tissue
infections are, as the name implies, infections that affect the soft tissue by causing necrosis. They spread along the fascial layers and can be either monobacterial or multibacterial in origin. Although they are most often associated
References
1.Anaya DA, Dellinger EP.
Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis 2007; 44: 705–10.
2. Meleney F. Hemolytic
Streptococcus gangrene. Arch Surg 1924; 9: 317–64.
3. Patino JF, Castro D. Necrotizing lesions of soft tissues: a review. World J Surg 1991; 15: 235–9.
4. Green RJ, Dafoe DC, Raffin TA. Necrotizing fasciitis. Chest 1996; 110: 219–29.
5. Dellinger EP. Severe necrotizing soft-tissue infections: multiple disease entities requiring a
common approach. JAMA 1981; 246: 1717–21.
6. Fagan S, Spies M, Hollyoak M,
Muller MJ, Goodwin CW, Herndon DN. Exfoliative and necrotizing diseases of the skin. In: Herndon DN (Ed). Total Burn Care, third edition. SAUNDERS-Elsevier, 2007: 554–562.
with surgical wounds, they can also occur in tiny cracks or breaks in the skin. They are considered surgical wound infections because the treatment involves surgical excision in addition to antibiotic administration, unlike non-necrotising soft tissue infections that require antibiotics only. However, in the years since NSTIs were
first discovered, many classifications and terms have been used to describe them
MICROBIOLOGY NSTI is classified into two types based on the microbial pathogens involved and the immune status of the patient[6]
.
Type 1 Type 1 occurs in about 20% of cases. Patients are typically healthy young individuals with an uncompromised immune system. These infections are usually monomicrobial in origin and caused mainly by group A Streptococcal infection or Staphylococcus aureus. A few cases will be caused by Clostridium species, and when associated
Figure 1: A six-year-old boy presenting with septic shock and rapid deterioration. The arrow points to areas of skin necrosis. Note that even though the scrotal skin was bluish in colour, the supra-pubic area was normal.
and there has been confusion surrounding their diagnosis and management[1–5] This review will focus on the diagnosis, management and outcome of this condition.
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Wounds International Vol 2 | Issue 4 | ©Wounds International 2011
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