Necrotising Fasciitis

Question 1

what is necrotising fasciitis

Answer 1

life-threatening infection of the subcutaneous soft tissue, with spread along the fascial planes but not the underlying muscle

Question 2

theres 4 types of necrotising fasciitis… what are the most common 2 types

Answer 2

The most common are type 1 (polymicrobial infection with anaerobes)

and type 2 (monomicrobial infection with group A streptococci

Question 3

risk factors for necrotising fasciitis

Answer 3

inpatient contact with index case

Varicella zoster infection

cutaneous injury, surgery, trauma/ IV drug abuse

non-traumatic skin lesions

Question 4

what symptoms does a patient with necrotising fasciitis present with

Answer 4

anaesthesia/ severe pain over site of infection

fever

palpitations, tachycardia, tachypnoea, hypotension, lightheadedness, N&V

Question 5

findings on physical examination

Answer 5

On physical examination the affected region will be blistering and erythematous.

In early stages mild oedema may be the only sign.

There will either be severe pain or anaesthesia over the site of cellulitis.

In advanced cases, the skin may be grey, with overlying crepitus.

The patient is typically pyrexial, tachycardic, tachypnoeic, and hypotensive

Question 6

what investigations will be done for necrotising fasciitis

Answer 6

surgical exploration, blood culture, tissue culture, gram stain, FBC

Question 7

management of necrotising fasciitis

Answer 7

Management is with haemodynamic support, urgent debridement surgery, and broad-spectrum antibiotics.

Radiography or CT/MRI can confirm the diagnosis, but should not delay surgery

Question 8

prognosis

Answer 8

Mortality from necrotising fasciitis properly treated with surgery plus antibiotics has been estimated at between 10% and 40%.

Mortality is higher in patients who develop shock and end-organ damage, approaching 50% to 70%