necrotising fascitis

Question 1

What is type 1

Answer 1

caused by mixed anaerobes and aerobes (often occurs post-surgery in diabetics). This is the most common type

Question 2

What is type 2

Answer 2

caused by Streptococcus pyogenes

Question 3

What are the risk factors

Answer 3

skin factors: recent trauma, burns or soft tissue infections
diabetes mellitus
the most common preexisting medical condition
particularly if the patient is treated with SGLT-2 inhibitors
intravenous drug use
immunosuppression

Question 4

What is the most affected site

Answer 4

The perineum - Fournier’s gangrene

Question 5

What are the features

Answer 5

acute onset
pain, swelling, erythema at the affected site
often presents as rapidly worsening cellulitis with pain out of keeping with physical features
extremely tender over infected tissue with hypoaesthesia to light touch
skin necrosis and crepitus/gas gangrene are late signs
fever and tachycardia may be absent or occur late in the presentation

Question 6

What is the management

Answer 6

urgent surgical referral debridement
intravenous antibiotics
Haemodynamic support