Necrotizing lesions of soft tissues: A review

Abstract

Necrotizing lesions of the soft tissues are grave entities not infrequently seen in daily surgical practice. They may occur with epidemic proportions after natural disasters, representing a serious challenge to the surgeon since they are characteristically associated with high mortality rates unless an early diagnosis is made and prompt aggressive surgical management is initiated. Necrotizing fasciitis is the currently accepted generic term to encompass into a single category the diverse syndromes of progressive gangrenous infections of the skin and subcutaneous tissues. Necrotizing fasciitis must be viewed as a clinical entity rather than a specific type of infection: it is a clinical infection most commonly caused by a mixed aerobic/anaerobic synergistic polymicrobial combination. Zygomycetes may appear as major causal organisms (mucormycosis) and they should be actively searched for. Initial diagnosis of necrotizing fasciitis is established through the characteristic physical signs. Gram stain, and, in some doubtful cases, through frozen-section tissue biopsy. Aggressive and urgent radical debridement is the key to survival, combined with wide-spectrum antibiotic therapy.

Necrotizing soft-tissue infections: our experience at rural tertiary care centre

“…6,11 Multiple large series have reported associations between necrotizing soft tissue infections and the presence of chronic co-morbidities, particularly the presence of diabetes mellitus and obesity (30-97% range). 3,6,11,13 Various etiologic factors like injection, trauma, insect bites, chronic wounds/ulcers (such as diabetic foot ulcer), postoperative infections, perirectal abscesses, etc. Idiopathic necrotizing soft tissue infections (those occurring in previously healthy patients without an obvious source) constitute up to 20% of causes in major series.…”

“…Making a high level of suspicion a key factor in diagnosing the disease in patients that may not have a typical history. 3,15 A wide range of signs and symptoms can be seen in patients with necrotizing soft tissue infections. Initial findings include erythema, swelling of affected part followed by blister / bullae, discoloration of skin, necrosis of skin, discharge of toxic fluid / pus often associated with localized pain, fever and tachycardia.…”

“…1 Since then, multiple descriptions of NSTI have been published, and a wide number of terms, definitions, and classifications have been used. [2][3][4][5] In 1951, Wilson coined the term "necrotizing fasciitis" to encompass some of these infections that is rapidly spreading and potentially devastating infection of the superficial and deep fascia with secondary necrosis of the overlying skin. 6 The early diagnosis is main challenge in treating patients with NSTI, and knowledge of various clinical sign and laboratory markers can be helpful for distinguishing between cases of cellulitis, which should respond to medical management alone, and NSTI, which requires operative debridement in addition to antimicrobial therapy combined with close monitoring and supportive measure.…”

“…Making a high level of suspicion a key factor in diagnosing the disease in patients that may not have a typical history. 3,15 The purpose of this article is to assess the different diagnostic tools. (Biochemical marker, physical signs) as prognostic factors to determine the course of disease and to assess various treatment modality for NSTIs.…”

A cluster of cases of streptococcal necrotizing fasciitis in Gloucestershire

“…The mortality of NF is high in most series (25% or more), including those of recent years [12,13,[15][16][17][18]. Age [23].…”