Necrotizing Fasciitis: A Surgical and Medical Emergency

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.