Plastic Surgery

Question 1

Definition of necrotising fasciitis

Answer 1

Necrotising fasciitis is a life-threatening subcutaneous soft-tissue infection that may extend to the deep fascia, but not into the underlying muscle. The causal organisms may be aerobic, anaerobic, or mixed flora.

Question 2

What are the two types of necrotising fasciitis?

Answer 2

• Type I necrotising fasciitis is a polymicrobial infection with an anaerobe such as Bacteroides or Peptostreptococcus and a facultative anaerobe such as certain Enterobacterales or non-group A streptococcus.
• Type II necrotising fasciitis is most commonly a monomicrobial infection with Streptococcus pyogenes (group A streptococci).

Question 3

Risk factors of necrotsing fasciitis

Answer 3

diabetes mellitus
chronic corticosteroid use
alcohol abuse
injection drug use

Question 4

What is the pathogenesis of necrotising fasciitis?

Answer 4

• Inciting infection at tissue site can be accomplished via hematogenous spread or direct inoculation
• Infection rapidly spreads leading to:
• vascular occlusion → ischemia and necrosis
• crepitus in cases of gas forming organisms (e.g., Clostridium) and anaerobic organisms

Question 5

Prognosis of necrotising fasciitis

Answer 5

increased mortality and risk of amputation

Question 6

Symptoms of necrotising fasciitis

Answer 6

severe pain - out of proportion of superficial findings of the affected area

fever

Question 7

Signs of necrotising fasciitis