Necrotizing Fascilitis (Nec Fasc)

Etiology

  • Deep infection of the soft tissue, affecting above and below fascia (muscle involvement)
  • Progresses rapidly, causing vascular thrombosis, facilitating spread
  • Can be from direct inoculation/skin breakdown/trauma or hematogenous seeding
  • Poly-microbial (aerobes and anaerobes) tends to occur in elderly/compromised; single organism (grp A strep, staph, vibrio, aeromonas, other) in any age
  • In GU/Perineum area called Fourniers

Risk Factors

  • Bacteremia
  • Assoc w/older age, diabetes, vascular disease, impaired immunity or perfusion
  • Trauma (clostridium), tissue injury, or other point of entry for organisms

Symptoms

  • Acute pain
  • Swelling
  • Fever
  • Toxic appearing
  • Often rapidly progressive

Physical Exam Findings

  • Typically abnl vital signs consistent w/severe illness
  • Edema, redness, bulla, dark discoloration/necrosis
  • Initial findings can be subtle; more profound as dz progresses
  • Sometimes crepitus from gas formation
  • Intraoperative findings: "dishwater" fluid (gray/watery), liquefied fat, non-viable tissue (sub-cu, fascia, muscle), easy to pass finger along fascial planes

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