Necrotizing Fasciitis

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

Wounds. 2002;14(8)

Conclusion

NF is a rare, rapidly progressive, soft-tissue infection characterized by extensive necrosis of the skin and subcutaneous tissue. In order to decrease the mortality rate of this life-threatening condition, rapid diagnosis, immediate surgical intervention, and broad-spectrum antibiotics are critical. However, other adjuvant therapies have been considered, such as hyperbaric oxygen and intravenous immunoglobulin.

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Reprint Address

Address correspondence to: Robert S. Kirsner, MD, University of Miami/Veterans Administration Medical Center, 1201 NW 16th St., Miami, FL 33125 Phone: (305) 324-3167; Fax: (305) 324-3125; E-mail: Rkirsner@med.miami.edu

Cite this: Necrotizing Fasciitis - Medscape - Oct 01, 2002.

Table 1. Table 1. Predisposing factors associated with NF
Medications
Chemotherapy Steroids Long-term antibiotics Infliximab FK506 NSAIDS Other immunosuppressive medications
Cardiac
Arteriosclerosis Congestive heart failure
Endocrine
Diabetes mellitus
Trauma
Blunt or penetrating Laceration Injection/intravenous drug abuse Insect or animal bite Frostbite Surgery Open fracture
Renal
Renal failure Renal stones
Immunosuppression
AIDS Malignancy Tuberculosis Medications
Dermatologic
Lupus Porphyria cutanea tarda Skin abscess Psoriasis Varicella Skin burrows Skin ulcers
Gastrointestinal
Diverticulitis Perirectal abscess Perforated viscous
Other
Malnutrition Obesity Pregnancy/postpartum Advanced age

Table 2. Table 2. Causative organisms in NF
Type 1 NF
Gram-positive bacteria Streptococcus (not group A) Staphylococcus Corynebacterium
Gram-negative bacteria Fusobacterium Escherichia Enterobacter Proteus Klebsiella Serratia Eikenella Pseudomonas Vibrio Shigella Neisseria Pasteurella Salmonella
Anaerobes Bacteroides Peptococcus Clostridium
Fungi Candida Cryptococcus Histoplasma
Type 2 NF
Gram-positive bacteria Group A Streptococcus +/- Staphylococcus

Table 3. Table 3. Systemic manifestations of NF
Chills Constitutional symptoms Death Decreased urinary output Fever Mental status change Multiorgan system failure Neuralgia Shock Tachycardia Tachypnea Toxic appearance Weakness/fatigue

Table 4. Table 4. Diagnostic aids of NF
Laboratory
Acidosis Aldolase Disseminated intravascular coagulation Elevated creatinine Elevated creatinine phosphokinase Elevated sedimentation rate Hypocalcemia Hypoalbuminemia Leukocytosis with left shift Normochromic, normocytic anemia Rapid strep screen
Radiologic
CT scan MRI Ultrasound X-ray
Microscopic
Blood culture Gram stain and culture Tissue culture
Histologic
Fascial biopsy Fine needle aspiration Frozen section Incisional biopsy

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Necrotizing Fasciitis

Conclusion

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