Necrotizing fasciitis

Rare, life-threatening rapidly progressive infection involving primarily the fascia and the subcutaneous tissue, with thrombosis of the cutaneous microcirculation.

500-1500 cases annually in the U.S.

Early operative debridement reduces mortality.

A surgical emergency and all patients need debridement.

A rare postpartum complication.

Early surgical management associated with mortality rates 20-50%.

Management with antibiotics alone associated with a mortality rate approaching 100%.

Is a rapid progressive process over hours to days rather than weeks.

Gas gangrene is an infection associated with tissue death caused by gas forming bacteria- these infections may be polymicrobial or due to clostridium species.

Mortality 34%.

Second-look procedures should be performed within 12-24 hours after surgical debridement to ensure control of infection.

Present with pain, swelling, tenderness erythema and fever.

Most infections are polymicrobial , ref2242ed to Type I infections, are seen in immunologically compromised or postoperative patients.

Type II infections are due to a single bacterial pathogen.

Type II necrotizing soft-tissue infections usually involves group A streptococcus.

Type II necrotizing soft-tissue infections may involve MRSA, group B streptococci, klebsiella and other organisms.

Type III infections involve clostridium species..

Patients experience necrosis of fascia and other tissues, fever, hypotension, tachycardia, erythema, induration, bullae, crepitus, ecchymosis, subcutaneous, gas, discoloration of tissues and necrosis.

Postpartum necrotizing soft tissue infections typically occur within the first few days after the delivery.

Clinical diagnosis has a low sensitivity.

Laboratory findings include leukocytosis, and commonly hyponatremia.

Most patients have marked clinical improvement within 24 to 48 hours of debridement, and relapses occur hours or days after surgery.

Late relapses after debridement are rare.

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