Necrotising Fascitis

Question 1

how is necrotising fascitis characterised ?

Answer 1

type 1 - caused by mixture of anaerobes and aerobes - often occurs post surgery in diabetics

type 2 - strep pyogens

Question 2

what are risk factors for necrotising fascitis ?

Answer 2

trauma
burn
tissue infection

DIABETES MELLITUS !!! - particularly using SGLT -2 inhibitor (dapagliflosozin)

IV drug user

immunosuppression

Question 3

what is the most commonly affected sit for necrotising fascitis ?

Answer 3

perineum - fournier’s gangrene

Question 4

what are the clinical features for necrotising fascitis ?

Answer 4

acute onset
pain - swelling ,erythema maybe starting out small but rapidly worsening cellulitis with so much PAIN
PAIN IS OUT OF KEEPING WITH THE CLINICAL PICTURE
EXTREMELY TENDER TO TOUCH
SKIN necrosis and crepitus and gas gangrene are late signs

Question 5

management of necrotising fascitis ?

Answer 5

urgent surgical debridement
IV antibiotics

if streptococcal in nature - then IV immunoglobulin can be used as an ADJUCT only if strep toxic shock syndrome caused