Necrotizing fasciitis

The importance of early diagnosis, prompt surgical debridement and adjuvant therapy

Research output: Contribution to journalReview article

13 Citations (Scopus)

Abstract

Background: Necrotizing Fasciitis (NF) is a necrotizing soft tissue infection involving the fascia and subcutaneous tissue that can cause rapid local tissue necrosis and life-threatening severe sepsis. Aim: This article aims to review the aetiopathogenesis, investigations and management based on a literature review. Methods and Materials: The Medline literature search of relevant articles restricted to English language on necrotizing fasciitis was conducted and reviewed. Results: Necrotizing fasciitis is rare with an incidence ranging from 0.15 to 0.55 cases per 100,000 of the population. Accurate assessment and timely intervention are critical in the treatment of patients affected with NF. Understanding the history and unique characteristics of this disease is crucial to achieve early recognition, effective treatment and a favorable outcome. Classic symptoms include severe pain out of proportion to local findings, erythema, mottling, crepitus, skin anesthesia, warmth, tenderness, hemorrhagic bullous formation, edema in the affected area and fever. Predisposing conditions of NF are classified into 2 main categories (type I and II) based on causative microorganisms. Radical surgical debridement, broad spectrum antibiotics, negative pressure wound dressings, and hyperbaric oxygen therapy are considered to be the cornerstone of treatment. The mortality rate ranges widely from 10% to 75% and is related to delay in initial debridement, patient age of more than 60 years, associated hypotension, acidosis, bacteremia, renal failure, hyponatremia, peripheral vascular disease, myonecrosis and myositis. Conclusion: Necrotizing fasciitis is a devastating infection of the fascia and subcutaneous tissue. The presentation of the disease is nonspecific and variable. Delay in recognition and effective treatment increases the mortality. Prompt radical surgical debridement, appropriate antibiotics and adjuvant therapy contribute to an improved outcome.

Original languageEnglish
Pages (from-to)107-118
Number of pages12
JournalNorth American Journal of Medical Sciences
Volume3
Issue number3
DOIs
Publication statusPublished - Mar 2011

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Necrotizing Fasciitis
Debridement
Early Diagnosis
Fascia
Subcutaneous Tissue
Therapeutics
Negative-Pressure Wound Therapy
Anti-Bacterial Agents
Hyperbaric Oxygenation
Soft Tissue Infections
Myositis
Peripheral Vascular Diseases
Mortality
Hyponatremia
Erythema
Bacteremia
Acidosis
Hypotension
Renal Insufficiency
Edema

Keywords

  • Debridement
  • Hyperbaric oxygen
  • Myonecrosis
  • Necrotizing fasciitis
  • Streptococcal toxic shock syndrome

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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title = "Necrotizing fasciitis: The importance of early diagnosis, prompt surgical debridement and adjuvant therapy",
abstract = "Background: Necrotizing Fasciitis (NF) is a necrotizing soft tissue infection involving the fascia and subcutaneous tissue that can cause rapid local tissue necrosis and life-threatening severe sepsis. Aim: This article aims to review the aetiopathogenesis, investigations and management based on a literature review. Methods and Materials: The Medline literature search of relevant articles restricted to English language on necrotizing fasciitis was conducted and reviewed. Results: Necrotizing fasciitis is rare with an incidence ranging from 0.15 to 0.55 cases per 100,000 of the population. Accurate assessment and timely intervention are critical in the treatment of patients affected with NF. Understanding the history and unique characteristics of this disease is crucial to achieve early recognition, effective treatment and a favorable outcome. Classic symptoms include severe pain out of proportion to local findings, erythema, mottling, crepitus, skin anesthesia, warmth, tenderness, hemorrhagic bullous formation, edema in the affected area and fever. Predisposing conditions of NF are classified into 2 main categories (type I and II) based on causative microorganisms. Radical surgical debridement, broad spectrum antibiotics, negative pressure wound dressings, and hyperbaric oxygen therapy are considered to be the cornerstone of treatment. The mortality rate ranges widely from 10{\%} to 75{\%} and is related to delay in initial debridement, patient age of more than 60 years, associated hypotension, acidosis, bacteremia, renal failure, hyponatremia, peripheral vascular disease, myonecrosis and myositis. Conclusion: Necrotizing fasciitis is a devastating infection of the fascia and subcutaneous tissue. The presentation of the disease is nonspecific and variable. Delay in recognition and effective treatment increases the mortality. Prompt radical surgical debridement, appropriate antibiotics and adjuvant therapy contribute to an improved outcome.",
keywords = "Debridement, Hyperbaric oxygen, Myonecrosis, Necrotizing fasciitis, Streptococcal toxic shock syndrome",
author = "Machado, {Norman Oneil}",
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N2 - Background: Necrotizing Fasciitis (NF) is a necrotizing soft tissue infection involving the fascia and subcutaneous tissue that can cause rapid local tissue necrosis and life-threatening severe sepsis. Aim: This article aims to review the aetiopathogenesis, investigations and management based on a literature review. Methods and Materials: The Medline literature search of relevant articles restricted to English language on necrotizing fasciitis was conducted and reviewed. Results: Necrotizing fasciitis is rare with an incidence ranging from 0.15 to 0.55 cases per 100,000 of the population. Accurate assessment and timely intervention are critical in the treatment of patients affected with NF. Understanding the history and unique characteristics of this disease is crucial to achieve early recognition, effective treatment and a favorable outcome. Classic symptoms include severe pain out of proportion to local findings, erythema, mottling, crepitus, skin anesthesia, warmth, tenderness, hemorrhagic bullous formation, edema in the affected area and fever. Predisposing conditions of NF are classified into 2 main categories (type I and II) based on causative microorganisms. Radical surgical debridement, broad spectrum antibiotics, negative pressure wound dressings, and hyperbaric oxygen therapy are considered to be the cornerstone of treatment. The mortality rate ranges widely from 10% to 75% and is related to delay in initial debridement, patient age of more than 60 years, associated hypotension, acidosis, bacteremia, renal failure, hyponatremia, peripheral vascular disease, myonecrosis and myositis. Conclusion: Necrotizing fasciitis is a devastating infection of the fascia and subcutaneous tissue. The presentation of the disease is nonspecific and variable. Delay in recognition and effective treatment increases the mortality. Prompt radical surgical debridement, appropriate antibiotics and adjuvant therapy contribute to an improved outcome.

AB - Background: Necrotizing Fasciitis (NF) is a necrotizing soft tissue infection involving the fascia and subcutaneous tissue that can cause rapid local tissue necrosis and life-threatening severe sepsis. Aim: This article aims to review the aetiopathogenesis, investigations and management based on a literature review. Methods and Materials: The Medline literature search of relevant articles restricted to English language on necrotizing fasciitis was conducted and reviewed. Results: Necrotizing fasciitis is rare with an incidence ranging from 0.15 to 0.55 cases per 100,000 of the population. Accurate assessment and timely intervention are critical in the treatment of patients affected with NF. Understanding the history and unique characteristics of this disease is crucial to achieve early recognition, effective treatment and a favorable outcome. Classic symptoms include severe pain out of proportion to local findings, erythema, mottling, crepitus, skin anesthesia, warmth, tenderness, hemorrhagic bullous formation, edema in the affected area and fever. Predisposing conditions of NF are classified into 2 main categories (type I and II) based on causative microorganisms. Radical surgical debridement, broad spectrum antibiotics, negative pressure wound dressings, and hyperbaric oxygen therapy are considered to be the cornerstone of treatment. The mortality rate ranges widely from 10% to 75% and is related to delay in initial debridement, patient age of more than 60 years, associated hypotension, acidosis, bacteremia, renal failure, hyponatremia, peripheral vascular disease, myonecrosis and myositis. Conclusion: Necrotizing fasciitis is a devastating infection of the fascia and subcutaneous tissue. The presentation of the disease is nonspecific and variable. Delay in recognition and effective treatment increases the mortality. Prompt radical surgical debridement, appropriate antibiotics and adjuvant therapy contribute to an improved outcome.

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KW - Streptococcal toxic shock syndrome

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