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Gangrene and nectrotising fasciitis (Clinical presentation (Black skin …
Gangrene and
nectrotising fasciitis
Definitions
Gangrene
Death of tissue from
poor vascular supply
Necrotising fasciitis
Rapid progressive infection
of deep fascia with necrosis
of SC tissue
Pathophysiology
Gangrene
Wet
Tissue necrosis plus infection
associated discharge
Gas
Necrotising myositis caused by
Clostridia infection
Dry
Necrosis in absence of infection
Nec fasc
Infection of deep fascia and
subsequent necrosis of SC
Often B-haemolytic strep
Risk factors
DM
Trauma
Malignancy
Clinical
presentation
Black skin
discoloration
Reduced sensation
Reduced muscle strength
Local pain
Diagnosis
Examination
Cardio - signs of IE
Peripheral vascular - signs of critical ishemia
Investigations
Bedside
Obs - fever (infection), shock signs
Bloods
FBC (infection), CRP/ESR (infection).
U+E, LFT, clotting, glucose, lipids
Blood cultures (infection)
Swab
MCS
Imaging
X-ray limb (osteomyelitis)
History
HPC - appearance, pain
PMH - risk factors, PVD
SH - smoking, IVDU, diet
Management
Initial ABCDE
Definitive
Medical
IV abx
Indication: evidence of infection
E.g. IV benpen + clindamycin
Surgical
Debridement
Indication: necrotising fasciitis
Amputation
Indication: severe gangrene/nec fasc
Conservative
Smoking cessation
Identify cause
Referral
ASAP vascular/orthopods