A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes.
A comprehensive collection of OSCE guides to common clinical procedures. The clinical procedure guides include step-by-step images of key steps, video demonstrations and PDF mark schemes.
A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving.
A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations, including ABGs, LFTs, TFTs, ECGs, CXRs, AXRs and CTGs.
A comprehensive collection of medical revision notes that cover a broad range of clinical topics. These medical revision notes are ideal for medical students, junior doctors, physician associates, paramedics and nurses.
Surgery revision notes for medical students, including theatre basics (e.g. scrubbing, gowning, gloving), suturing, orthopaedic surgery, hepatobiliary surgery, neurosurgery and lots more.
A collection of anatomy notes covering the key anatomy concepts that medical students need to learn.
A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management.
A collection of free medical student quizzes (MCQ / EMQ / SBA) to put your medical and surgical knowledge to the test! Check out our brand new medical MCQ quiz platform at https://geekyquiz.com.
Table of Contents
Necrotising fasciitis is a potentially life-threatening infection of the fascia (the connective tissue between overlying the muscle). Popularly known as the “flesh-eating disease”.
Fournier’s gangrene – necrotising fasciitis of the perineum
Ludwig’s angina – necrotising fasciitis of the submandibular space
Organisms spread from the subcutaneous tissue along the superficial and deep planes.
Muscle is usually spared but myonecrosis can occur due to compartment syndrome.
Type 1 – polymicrobial infection (aerobic and anaerobic bacteria)
Type 2 – Group A Streptococcus: can occur in any age group and in healthy people
Type 3 – Gram-negative infection
Type 4 – fungal infection (e.g. candida in the immunocompromised or zygomycetes after traumatic wounds)
Have a high index of suspicion for necrotising fasciitis as a potential diagnosis if any of the following are present:
Necrotising fasciitis is a clinical diagnosis – if it is clinically felt to be likely, it should be ruled out by surgical exploration.
Radiology (should not delay essential surgical management):
Bedside finger test:
This is one of the few plastic surgery emergencies and the plastic surgery registrar should be informed as soon as possible.
Patients usually require immediate transfer to theatre for aggressive surgical debridement.
1. Resuscitate the patient (if haemodynamically unstable or in septic shock)
2. Commence IV antibiotics (this should usually be discussed with the local consultant microbiologist)
3. Consider whether the patient will need to be transferred to an intensive care unit whilst awaiting plastic surgery input
Consultant Plastic Surgeon
1. Tidy C. Necrotising Fasciitis. patient.co.uk. 2015 Jul 29. 2495 (v23)
2. Hasham S, Matteucci P, Stanley PR, et al; Necrotising fasciitis. BMJ, 2005 Apr 9 330 (7495):830-3.
3. Brooks A, Cotton BA, Tai N, Mahoney PF. Emergency Surgery Book. Wiley-Blackwell; 1st ed. 2010 Apr 13.
4. Semer NB. Practical Plastic Surgery for Nonsurgeons. Hanley & Belfus, Inc. Philadelphia. 2001
5. By Piotr Smuszkiewicz, Iwona Trojanowska and Hanna Tomczak [CC BY 2.0, via Wikimedia Commons]