Difference between revisions of "Necrotizing fasciitis"
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==General== | ==General== | ||
* | Clinical: | ||
* | *Pain - classic out-of-keep with appearance. | ||
*Features of sepsis - late. | |||
*Often nonspecific.<ref name=pmid22491537/> | |||
Clinical DDx: | |||
*Abscess. | |||
*Cellulitis. | |||
Epidemiology: | |||
*Classically associated with ''Group A streptococcus''. | *Classically associated with ''Group A streptococcus''. | ||
*High mortality.<ref name=pmid22491537/> | |||
*Usually adults, sometimes children. | |||
Treatment: | Treatment: | ||
*Operative debridement. | *Operative debridement - emergency.<ref name=pmid22491537>{{Cite journal | last1 = Lancerotto | first1 = L. | last2 = Tocco | first2 = I. | last3 = Salmaso | first3 = R. | last4 = Vindigni | first4 = V. | last5 = Bassetto | first5 = F. | title = Necrotizing fasciitis: classification, diagnosis, and management. | journal = J Trauma Acute Care Surg | volume = 72 | issue = 3 | pages = 560-6 | month = Mar | year = 2012 | doi = 10.1097/TA.0b013e318232a6b3 | PMID = 22491537 }}</ref> | ||
*Broad spectrum antibiotics. | |||
Note: | |||
*May be diagnosed at [[frozen section]].<ref name=pmid9386043>{{Cite journal | last1 = Majeski | first1 = J. | last2 = Majeski | first2 = E. | title = Necrotizing fasciitis: improved survival with early recognition by tissue biopsy and aggressive surgical treatment. | journal = South Med J | volume = 90 | issue = 11 | pages = 1065-8 | month = Nov | year = 1997 | doi = | PMID = 9386043 }}</ref> | |||
==Gross== | |||
Features:<ref name=pmid22151905>{{Cite journal | last1 = Schuster | first1 = L. | last2 = Nuñez | first2 = DE. | title = Using clinical pathways to aid in the diagnosis of necrotizing soft tissue infections synthesis of evidence. | journal = Worldviews Evid Based Nurs | volume = 9 | issue = 2 | pages = 88-99 | month = Apr | year = 2012 | doi = 10.1111/j.1741-6787.2011.00235.x | PMID = 22151905 }}</ref> | |||
*Subcutaneous emphysema. | |||
*Edema. | |||
*Erythema. | |||
*Bulae. | |||
*Skin sloughing. | |||
===Image=== | |||
<gallery> | |||
Image:Necrotizing_fasciitis_left_leg.JPEG | Necrotizing fasciitis. (WC) | |||
</gallery> | |||
==Microscopic== | ==Microscopic== | ||
Features: | Features: | ||
*Necrosis of fascia - '''key feature'''.<ref name=pmid15735411>{{Cite journal | last1 = Wong | first1 = CH. | last2 = Wang | first2 = YS. | title = The diagnosis of necrotizing fasciitis. | journal = Curr Opin Infect Dis | volume = 18 | issue = 2 | pages = 101-6 | month = Apr | year = 2005 | doi = | PMID = 15735411 | URL = http://www.sepeap.org/archivos/pdf/9859.pdf }}</ref> | *Necrosis of fascia - '''key feature'''.<ref name=pmid15735411>{{Cite journal | last1 = Wong | first1 = CH. | last2 = Wang | first2 = YS. | title = The diagnosis of necrotizing fasciitis. | journal = Curr Opin Infect Dis | volume = 18 | issue = 2 | pages = 101-6 | month = Apr | year = 2005 | doi = | PMID = 15735411 | URL = http://www.sepeap.org/archivos/pdf/9859.pdf }}</ref> | ||
**[[PMN]]s and necrotic debris (amorphous grey or pink material). | **[[PMN]]s and necrotic debris (amorphous grey or pink material). | ||
*+/-Vascular thrombosis.<ref>{{Cite journal | last1 = Malghem | first1 = J. | last2 = Lecouvet | first2 = FE. | last3 = Omoumi | first3 = P. | last4 = Maldague | first4 = BE. | last5 = Vande Berg | first5 = BC. | title = Necrotizing fasciitis: contribution and limitations of diagnostic imaging. | journal = Joint Bone Spine | volume = 80 | issue = 2 | pages = 146-54 | month = Mar | year = 2013 | doi = 10.1016/j.jbspin.2012.08.009 | PMID = 23043899 }}</ref> | |||
Note: | Note: | ||
Revision as of 04:00, 30 December 2013
Necrotizing fasciitis, also known as flesh-eating disease, is an uncommon non-malignant skin disease with a high mortality.
It should not to be confused with nodular fasciitis.
General
Clinical:
- Pain - classic out-of-keep with appearance.
- Features of sepsis - late.
- Often nonspecific.[1]
Clinical DDx:
- Abscess.
- Cellulitis.
Epidemiology:
- Classically associated with Group A streptococcus.
- High mortality.[1]
- Usually adults, sometimes children.
Treatment:
- Operative debridement - emergency.[1]
- Broad spectrum antibiotics.
Note:
- May be diagnosed at frozen section.[2]
Gross
Features:[3]
- Subcutaneous emphysema.
- Edema.
- Erythema.
- Bulae.
- Skin sloughing.
Image
Necrotizing fasciitis. (WC)
Microscopic
Features:
- Necrosis of fascia - key feature.[4]
- PMNs and necrotic debris (amorphous grey or pink material).
- +/-Vascular thrombosis.[5]
Note:
- Fat lobules between septae may be normal.
DDx:
Images
Necrotizing fasciitis - intermed. mag. (WC)
Necrotizing fasciitis - high mag. (WC)
See also
References
- ↑ 1.0 1.1 1.2 Lancerotto, L.; Tocco, I.; Salmaso, R.; Vindigni, V.; Bassetto, F. (Mar 2012). "Necrotizing fasciitis: classification, diagnosis, and management.". J Trauma Acute Care Surg 72 (3): 560-6. doi:10.1097/TA.0b013e318232a6b3. PMID 22491537.
- ↑ Majeski, J.; Majeski, E. (Nov 1997). "Necrotizing fasciitis: improved survival with early recognition by tissue biopsy and aggressive surgical treatment.". South Med J 90 (11): 1065-8. PMID 9386043.
- ↑ Schuster, L.; Nuñez, DE. (Apr 2012). "Using clinical pathways to aid in the diagnosis of necrotizing soft tissue infections synthesis of evidence.". Worldviews Evid Based Nurs 9 (2): 88-99. doi:10.1111/j.1741-6787.2011.00235.x. PMID 22151905.
- ↑ Wong, CH.; Wang, YS. (Apr 2005). "The diagnosis of necrotizing fasciitis.". Curr Opin Infect Dis 18 (2): 101-6. PMID 15735411.
- ↑ Malghem, J.; Lecouvet, FE.; Omoumi, P.; Maldague, BE.; Vande Berg, BC. (Mar 2013). "Necrotizing fasciitis: contribution and limitations of diagnostic imaging.". Joint Bone Spine 80 (2): 146-54. doi:10.1016/j.jbspin.2012.08.009. PMID 23043899.