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, including step-by-step images of key steps, video demonstrations and PDF mark schemes.
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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]