Practice Practice Pointer

Necrotising fasciitis

BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e4274 (Published 20 July 2012) Cite this as: BMJ 2012;345:e4274
  1. Helen Yasmin Sultan, consultant 1,
  2. Adrian A Boyle, consultant2,
  3. Nicholas Sheppard, specialist registrar3
  1. 1Emergency Department, West Suffolk Hospital, Bury St Edmonds IP33 2QZ,UK
  2. 2Emergency Department, Addenbrookes Hospital, Cambridge CB2 2QQ, UK
  3. 3Plastic and Reconstructive Surgery, Addenbrookes Hospital, Cambridge CB2 2QQ
  1. Correspondence to: A A Boyle adrian.boyle{at}addenbrookes.nhs.uk
  • Accepted 27 May 2012

Learning points

  • Necrotising fasciitis is a lethal and rapidly progressive soft tissue infection, which can occur in healthy young patients

  • People with diabetes, those who inject drugs, and patients with haematological malignancy are particularly at risk

  • Diagnosis requires a high index of suspicion. Consider necrotising fasciitis especially when the presentation is “not quite right” or the patient is not responding to treatment

  • Early surgical exploration of the soft tissues has little morbidity and may be the only means to reach a definitive diagnosis and expedite treatment

  • In established necrotising fasciitis, surgery gives a 60-80% chance of survival. The earlier the first exploration and subsequent debridement, the less extensive the resection and postoperative morbidity is likely to be

Necrotising fasciitis is one of a group of highly lethal infections that cause rapidly spreading necrosis of fascia and subcutaneous tissues, sometimes involving muscles and skin. They were previously known by such names as hospital gangrene, gas gangrene, and Fournier’s gangrene and are now referred to by the generic term “necrotising soft tissue infections.” We review the clinical features and highlight the potential pitfalls in diagnosis.

Methods

We searched Medline and the Cochrane Library using terms such as “necrotising fasciitis” and “Fournier’s gangrene.” We also drew on our own experience. The overall quality of evidence is weak to moderate.

How common is necrotising fasciitis?

About 500 cases of necrotising fasciitis a year occur in the United Kingdom.1 Although rare, the infection occurs often enough for most emergency department doctors and general practitioners to see a case in the course of a working lifetime. The key to successful treatment lies in early diagnosis and appropriate management.

This condition is catastrophic if missed. Even with surgery, mortality is 20-40%.2 3 Delay in diagnosis increases mortality,4 5 6 and those who survive need more extensive surgery, reconstruction, and often amputation. With …

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