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Necrotizing Fasciitis (Deeper Skin Infection) - Coggle Diagram
Necrotizing Fasciitis (Deeper Skin Infection)
Epidemiology
Can be rapidly limb/life-threatening
Can affect any body part but usually....
Extremities
Body wall
Especially in patients with high BMI
Male genitals
Fournier's gangrene
Frequently polymicrobial
Type 1
Polymicrobial
At least 1 anaerobic species + Streptococci,
Staph. aureus
, Enterobacteriaeceae
Locations
Head and new
Abdominal wall
Fournier's gangrene
Type 2
Single organism
Strep. pyogenes
Presents with...
Pain
Bullae
Often initially underdiagnosed
Can be associated with Streptococcal Toxic Shock Syndrome
Predisposing factors
Aetiology
Trauma
Surgery
Soft tissue infection
IV drug use
Burns
Muscle injuries
Risk factors
Immunosuppression
Diabetes mellitus
Corticosteroids
IV drug use
Obesity
Diagnosis
May look like cellulitis but with disproportionate pain
Immediate assessment/treatment required
Investigations
Tissue samples of affected area
Gram stain
Culture
Blood cultures
CT/MRI scan
Clinical Manifestations
Affected area is...
Red
Hot
Swollen
Tender
(May become) anaesthetic
Rapid progression of...
Skin discoloration
Bulla formation
Skin gangrene
Subcutaneous gas
Systemic toxicity is common
Treatment/Prevention
Immediately resuscitation
Early surgery
Debride all (necrotic) tissue involved in infection
Empirid broad spectrum IV antibiotics
Benzylpenicillin + Flucloxacillin + Ciprofloxacin + Clindamycin
May require critical care
Pathogenesis
Involves superficial and deep fascia layers and overlying subcutaneous fat
Travels along fascial plane
