Necrotising fasciitis
Necrotising fasciitis is a rapidly progressive inflammatory infection of the fascia, with secondary necrosis of the subcutaneous tissues
•also been referred to as hemolytic streptococcal gangrene, Meleney ulcer, acute dermal gangrene, hospital gangrene, suppurative fasciitis, and synergistic necrotizing cellulitis
•The frequency of necrotizing fasciitis has been on the rise because of an increase in immunocompromised patients with diabetes mellitus, cancer, alcoholism, vascular insufficiencies, organ transplants, HIV infection, or neutropenia.
✓symptoms and Findings
hallmark symptom of necrotizing fasciitis is intense pain and tenderness over the involved skin and underlying muscle.
•Other indicative findings include edema extending beyond the area of erythema, skin vesicles, and crepitus
•Local crepitation can occur in more than one half of patients
✓The lab results that maybe associated with necrotizing fascitis:
Elevated white blood cell (WBC count), possibly to more than 14,000/µL
Elevated blood urea nitrogen (BUN) level, possibly to greater than 15 mg/mL
Reduced serum sodium level.
∆management:
•surgical debridement: is continued until tissue necrosis ceases and the growth of fresh viable tissue is observed
•If a limb or organ is involved, amputation may be necessary because of irreversible necrosis and gangrene or because of overwhelming toxicity, which occasionally occurs
•Antibiotic therapy is a key consideration: combination of penicillin G and an aminoglycoside (if renal function permits), as well as clindamycin
•Once other modalities, including surgical debridement and antibiotic administration, have been used, hyperbaric oxygen therapy (HBOT) may be considered, if available.