Necrotizing fasciitis is a life-threatening infection that causes rapid destruction and necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage of the fascia Fascia Layers of connective tissue of variable thickness. The superficial fascia is found immediately below the skin; the deep fascia invests muscles, nerves, and other organs. Cellulitis and subcutaneous tissues. Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship may present with significant pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways out of proportion to the presenting symptoms and rapidly progressive erythema Erythema Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of disease processes. Chalazion of the affected area. Most patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship will also have systemic signs of infection, including fever Fever Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever, hypotension Hypotension Hypotension is defined as low blood pressure, specifically < 90/60 mm Hg, and is most commonly a physiologic response. Hypotension may be mild, serious, or life threatening, depending on the cause. Hypotension, altered mental status Altered Mental Status Sepsis in Children, and multisystem organ failure. The diagnosis is primarily clinical since patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship can quickly progress to septic shock Septic shock Sepsis associated with hypotension or hypoperfusion despite adequate fluid resuscitation. Perfusion abnormalities may include, but are not limited to lactic acidosis; oliguria; or acute alteration in mental status. Sepsis and Septic Shock without source control Source Control Surgical Infections. This type of infection is a surgical emergency Surgical Emergency Acute Abdomen and requires emergent surgical debridement Debridement The removal of foreign material and devitalized or contaminated tissue from or adjacent to a traumatic or infected lesion until surrounding healthy tissue is exposed. Stevens-Johnson Syndrome, parenteral antibiotics, and close hemodynamic monitoring.
Last updated: 1 Mar, 2021
Necrotizing fasciitis is divided into microbiologic categories based on the causative organism(s):
Early signs:
Late signs:
Common sites of infection:
Rapidly spreading erythema Erythema Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of disease processes. Chalazion, ulceration Ulceration Corneal Abrasions, Erosion, and Ulcers, and edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema of the right leg Leg The lower leg, or just “leg” in anatomical terms, is the part of the lower limb between the knee and the ankle joint. The bony structure is composed of the tibia and fibula bones, and the muscles of the leg are grouped into the anterior, lateral, and posterior compartments by extensions of fascia. Leg: Anatomy due to necrotizing fasciitis
Image: “Preoperative photograph” by Department of Family Medicine, Morehouse School of Medicine, 1513 East Cleveland Avenue, Building 100, Suite 300A, Atlanta, GA 30344, USA. License: CC BY 3.0Bullae Bullae Erythema Multiforme and erythema Erythema Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of disease processes. Chalazion resulting from necrotizing fasciitis
Image: “Superficial skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Skin: Structure and Functions manifestations of necrotizing fasciitis” by National Hospital of Sri Lanka, Regent Street, Colombo 10, Sri Lanka. License: CC BY 4.0Cutaneous necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage, erythema Erythema Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of disease processes. Chalazion, and bullous changes due to necrotizing fasciitis of the leg Leg The lower leg, or just “leg” in anatomical terms, is the part of the lower limb between the knee and the ankle joint. The bony structure is composed of the tibia and fibula bones, and the muscles of the leg are grouped into the anterior, lateral, and posterior compartments by extensions of fascia. Leg: Anatomy
Image: “Necrotizing fasciitis” by Piotr Smuszkiewicz et al AL Amyloidosis. License: CC BY 2.0Fournier
gangrene
Gangrene
Death and putrefaction of tissue usually due to a loss of blood supply.
Small Bowel Obstruction:
Significant
erythema
Erythema
Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of disease processes.
Chalazion and
edema
Edema
Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity).
Edema is noted throughout the
scrotum
Scrotum
A cutaneous pouch of skin containing the testicles and spermatic cords.
Testicles: Anatomy and gluteal regions.
Erythema
Erythema
Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of disease processes.
Chalazion and necrotic tissue due to necrotizing fasciitis of the
neck
Neck
The part of a human or animal body connecting the head to the rest of the body.
Peritonsillar Abscess:
This developed after a dental extraction.
Necrotizing fasciitis of the lip and face:
Significant
swelling
Swelling
Inflammation,
erythema
Erythema
Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of disease processes.
Chalazion, exfoliation, and purulent drainage is noted.
A definitive diagnosis of necrotizing fasciitis is made by surgical exploration and debridement Debridement The removal of foreign material and devitalized or contaminated tissue from or adjacent to a traumatic or infected lesion until surrounding healthy tissue is exposed. Stevens-Johnson Syndrome. These processes should not be delayed to obtain diagnostic information, if the clinical suspicion is high.
However, the following may be helpful:
CT findings in necrotizing fasciitis:
Gas is noted in the subcutaneous space.
CT findings in necrotizing fasciitis:
This scan demonstrates fascial
edema
Edema
Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity).
Edema,
subcutaneous fat
Subcutaneous fat
Fatty tissue under the skin throughout the body.
Erythema Nodosum stranding, and gas in the muscle compartments.
CT findings in necrotizing fasciitis:
This scan demonstrates subcutaneous gas tracking along fascial planes of the left
leg
Leg
The lower leg, or just “leg” in anatomical terms, is the part of the lower limb between the knee and the ankle joint. The bony structure is composed of the tibia and fibula bones, and the muscles of the leg are grouped into the anterior, lateral, and posterior compartments by extensions of fascia.
Leg: Anatomy and
pelvis
Pelvis
The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities.
Pelvis: Anatomy.
Surgical debridement Debridement The removal of foreign material and devitalized or contaminated tissue from or adjacent to a traumatic or infected lesion until surrounding healthy tissue is exposed. Stevens-Johnson Syndrome is the mainstay of treatment.
Surgical excision of necrotic tissues in necrotizing fasciitis
Image: “Management of necrotizing fasciitis” by 3rd Department of Surgery, Attikon University Hospital, University of Athens School of Medicine, Athens, Greece. License: CC BY 4.0