You are on page 1of 22

Necrotizing Fasciitis

Necrotizing Fascitiis

Definition
Risk factors
Etiology
Pathophysiology
Epidemiology
Clinical Features
Investigations
Management

Difficult to diagnose
Extremely toxic
Spread rapidly
May lead to limb amputation

Classification
@ Colistridial :
# Necrotizing cellulitis
# Myositis
@ Non-colistridial :
# NECROTIZING FASCIITIS
# Streptococcal gangrene

Necrotizing Fasciitis
It is a progressive, rapidly spreading,
inflammatory infection located in the
deep fascia with 2ry necrosis of the
subcutaneous tissue.

Risk Factors
Immunocompression illnesses
e.g.: DM, Cancer, alcoholism, vascular
insufficiency, organ transplant, HIV or
neutropenia.
Trauma or foreign bodies in surgical wound.
Idiopathic as scrotal or penile necrotizing
fasciitis.

Causative Agents
It is a mixed microbial flora:
#
#
#
#

microaerophilic streptococci.
staphylococci.
aerobic gram ve
anaerobes ( peptostreptococi

bacteroids)

Pathophysiology

Mortality & Morbidity


The overall morbidity & mortality is 70
80%
Fourniers gangrene has a reported
mortality as high as 75%

Sex:

Male : Female

3:1

Age:
years.

* the mean age is 38 to 44


* pediatric cases are rare but
reported from countries where
poor hygiene in.

Clinical Features
Symptoms:
*sudden onset of pain and swelling
at the site of trauma or recent surgery.
*in some cases, the symptoms
may begin at the site distant from the
initial traumatic insult.
*Fournier's gangrene begin with
pain and itching of the scrotal skin.

Clinical Features (cont.)


Sings:
* pt. appears moderately to severely toxic (but
sometimes might looks well)
* typically, erythema that quickly spread over a course
of hours to days.
* the redness quickly spread & the margin of infection
move out into normal skin without being raised nor sharply
demarcated.
* anesthesia
# Note:
*I.M. injections & I.V. infusions may lead to necrotizing
fasciitis.
*minors insect bites may set the stage for necrotizing
infections.

Investigations
Lab: CBC, U&E, Glu, Creatinine, Blood
&
tissue cultures, Urine analysis,
&
ABG.

Investigations (cont.)
Imaging Studies:
# X-ray gas in the subcutaneous
fascia planes.
?? D.D. of subcutaneous gas in a
radiograph.
# C.T. demonstrating necrosis with
asymmetric fascial thickening
& gas in the tissues.
# MRI.

Investigations (cont.)
Microbiology:
Gram stain & wound culture

Procedures:
Biopsy is the best method to use to obtain
proper cultures for micro-organisms.

Management
If streptococci are the identified major
pathogens, the D.O.C is Penicillin-G with
clindamycin as an alternative.
To ensure adequate treatment, we have to
cover aerobic & anaerobic bacteria.
The anaerobic coverage can be provided by
Metronidazole or 3rd generation
cephalosporin's.

Management (cont.)
Gentamicine combined with
clindamycine or chloramphenicol has
been reported as a standard
coverage.
Ampicilline may be added to the basic
regimen to treat enterococci if
suspected by gram stain.

Further In-Patient Care


1. Surgical debridment.
2. Fasciotomy.
3. H.B.O.

Complications
Renal Failure.
Septic Shock with cardiovascular
collapse.
Scarring with cosmetic deformity.