Abstract
Necrotizing fasciitis (NF) is still remained a dreaded disease with high morbidity and mortality due to rapidly progressive necrotizing infection. Objective: Review recent available literature on necrotizing fasciitis (NF) and compare it with our publications. Data and Source: Local and international published literature on NF from early nineties to 2012; Midline and pub Med literature search using the term “necrotizing fasciitis”. Data Synthesis: NF is more common in male patient, it is frequently polymicrobial. Common site of NF is the extremities. NF is classified according to the microbes. Common co-morbid condition associated with NF is diabetes mellitus. Minor trauma and surgery are the major etiological risk factors for NF. There seems to be significant correlation between the use of non steroidal anti-inflammatory medication (NSAID) and NF. Severe pain disproportionate to injury is the presenting symptom. Laboratory risk indicators for necrotizing fasciitis (LRINEC) score will diagnose NF early in emergency clinics. Tissue biopsy is the gold standard for the diagnosis of NF. Pathophysiology of NF is rapid horizontal spread of infection with fascial necrosis and secondary vertical involvement of skin. More than 90% of NF patients need intensive care therapy. Early and bold debridement in combination with brave organ supportive intensive care will have better outcome of NF patients. Conclusion: High index of suspicion and knowledge is essential for early diagnosis of NF. Finger test and LRINEC score may help in early diagnosis. Early debridement, proper antibiotics and organ supportive intensive care will improve morbidity and mortality of NF patients.
Highlights
Necrotizing fasciitis (NF) is a rapidly progressing, inflammatory infection of the fascia with the secondary involvement of skin, subcutaneous tissues and muscle [1]
Wong et al depending on hypothesis that these basic above mentioned profiles may help in the early diagnosis of NF, did a comparative study between cellulitis and NF; designed the laboratory risk indicatotors for necrotizing fasciitis (LRINEC) score
Necrotizing fasciitis is a life and limb threatening rapidly progressive necrotizing infection. It is commonly polymicrobial and methicilin resistant staphylococcal infection (MRSA) necrotizing fasciitis is on rise
Summary
Necrotizing fasciitis (NF) is a rapidly progressing, inflammatory infection of the fascia with the secondary involvement of skin, subcutaneous tissues and muscle [1]. NF is a limb and life threatening surgical emergency; we added the term medical emergency as it requires emergent and aggressive medical care as most of these patients are managed in the intensive care unit [2]. NF is recognized as dreaded disease from the days of Hippocrates; Fournier in late eighteen century documented necrotizing infection of the perineal and genital area; which is still known as Fournier’ gangrene. High morbidity and mortality associated with NF makes it an emergency; early debridement will have a favourable outcome. All above explanations dictate that the NF a limb and life threatening surgical as well as medical emergency
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