Necrotizing Fasciitis

Jennifer T. Trent, MD, Robert S. Kirsner, MD

Disclosures

Wounds. 2002;14(8) 

In This Article

Abstract and Introduction

Abstract

Necrotizing fasciitis (NF) is a rare, life-threatening infection resulting in necrosis of the skin, subcutaneous tissue, and fascia. Mortality rates have been noted as high as 73 percent. Certain conditions can predispose patients to NF, such as diabetes mellitus, immunosuppressive medications, and AIDS. Patients usually complain of excessive pain as well as constitutional symptoms. Cutaneous findings include diffuse redness and edema progressing to necrosis and hemorrhagic bullae. Because of this rapid progression, it is important to diagnose and treat NF quickly to decrease mortality. Treatment includes broad-spectrum antibiotic coverage, nutritional supplements, hemodynamic support, wound care, and prompt surgical debridement.

Introduction

Necrotizing fasciitis (NF) is a rare, life-threatening, soft-tissue infection characterized by rapidly spreading inflammation and necrosis of the skin, subcutaneous fat, and fascia.[1] The incidence of NF in adults has been reported to be 0.40 cases per 100,000 population, while the incidence in children is 0.08 cases per 100,000 population.[2,3] Despite the uncommon nature of this condition, over the last decade, there has been a five-fold increase in the incidence of NF.[4] Although largely unexplained, the aging of the population and the increase in numbers of immunosuppressed individuals may be related. Rapid early intervention may prevent morbidity and mortality, but, left untreated, mortality rates as high as 73 percent have been reported.[1] Mortality varies with age, with increasing mortality seen in older age groups. For example, patients over 50 years of age have a mortality rate of 37 percent, while those over 60 years of age have a mortality rate of 62 percent.[5]

The earliest reference to this condition was made by Hippocrates in the 15th century BC, who spoke of it as a complication of erysipelas.[1,6] However, the term necrotizing fasciitis was not coined until 1952. Over the years, other terms have been used to refer to NF, including flesh-eating bacteria syndrome, suppurative fasciitis, hospital gangrene, and necrotizing erysipelas.[2,7,8]

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