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Necrotizing Fasciitis
Justina Du, Thao Nguyen,
Camille Thorsen
What is Necrotizing Fasciitis?
• life-threatening, progressive, rapidly spreading, inflammatory
infection located in the deep fascia.
• infection rapidly destroy the skin and soft tissue beneath it
• Also known as: “flesh-eating” bacteria.
• Other names: β-hemolytic streptococcal gangrene, Meleney ulcer,
acute dermal gangrene, hospital gangrene, and necrotizing
cellulitis.
• 3 types of NF.
– Type I : a polymicrobial flora.
– Type II Group A β-Streptococcus bacteria (most common
case)
– Type III : marine vibrio gram-negative rods.
How does one contract NF?
• exposed to an individual with an opening in their
skin.
– direct contact with someone carrying the bacteria
– the bacterium being carried by the person itself.
• sight of entrance can be as minor as a paper cut
or a pin prick.
• enter through weakened skin, as a contusion, a
bruise, a blister, or even an abrasion.
• Can happen to anyone!!!!!!
Cofactors that Increase risks
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Diabetes
Alcoholism
Immuno-suppression
Severe illnesses: heart, lung, or liver
disease
• Obesity
What’s going on inside your
body?
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Bacteria eat away at tissue between skin and muscle
Increase in sensitivity or anaesthetic feel to the skin itself
Inflammatory response by immune system
Bacterial toxins released
Cytokines impede function of phagocytic cells
– Anaerobes thrive speeding up necrotic process
Endothelial cells become damaged;
– Increased permeability of the lining of vessels in the body
Poor blood supply inhibit:
– Inflammatory response process
– Ability for the immune system to properly work
– Ability to transfer antibiotics to the affected fascial layer
Vasoconstriction and thrombosis  edema  hypoxia  necrosis of the fascia, skin,
soft tissue, and muscles.
Additional necrosis involving the subcutaneous nerves.
What are the early symptoms and
signs of NF?
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Flu like symptoms that include
fever, chills, nausea, weakness,
dizziness, aches and a heat rate of
more than 100 beats per minute.
Skin becomes tender, warm, red
in color, and will start to swell.
Patients may experience pain
greater than expected from the
appearance of the wound.
Subcutaneous tissue may also
have a hard feel on palpation that
goes past the visibly infected area.
Clinically indistinguishable from
other possible soft tissue
infections with only the
presentation of pain, tenderness,
and warm skin.
Advanced symptoms…
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The advanced symptoms appear
as the disease progresses
The area of the body experiencing
pain begins to swell excessively.
Multiple discolored patches
develop to produce a large area of
gangrenous skin.
Initial necrosis appears as a
massive destruction of the skin
and subcutaneous layer.
The normal skin and subcutaneous
tissue are loosened.
Large, dark marks that become
blisters filled with a yellow-green
necrotic fluid appear.
Critical symptoms…
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The critical symptoms form in the last stages of NF.
30% of patient’s develop hemorrhagic bullae which
may cause them to become anemic.
Vasculature of the skin becomes inflamed and
thrombosed. Resulting in necrotic eschars that look
like deep thermal burns.
Without treatment, secondary involvement of
deeper muscle layers may occur.
Patients may become numb because of nerve
damage and progressing gangrene in the infected
area.
Unconsciousness will occur as the body becomes
too weak to fight off the infection along with a
severe decrease in the patient’s blood pressure.
As toxins are being released, the body’s organ may
go into septic shock while contracting a high fever,
high white blood count, and becoming disoriented.
This may result into respiratory failure, heart failure
and renal failure.
Exams and Laboratory Testing
• In order to get a definitive diagnosis of NF, physicians
look for abnormalities in the test results that are
characteristics of the disease.
• Some of these tests include:
1. Blood samples
2. Testing for elevated or lowered creatinine, glucose,
CPK, bicarbonate, albumin, and calcium levels.
3. X-ray
4. CT, and MRI scanning
5. And most importantly antibiotic culture and sensitivity
tests
Treating NF
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Early diagnosis and treatment is vital
Emergency debridement
IV antibiotic treatment
Hyperbaric oxygen therapy is recommended for anaerobic organisms
Morphine drip and a patient-controlled analgesia pump to control
pain
Soft tissue reconstruction
Monitor nutrition
If sepsis has set in, vasoconstricting medications should be given.
Education and counseling
PREVENTION!!!
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Most people are in good health
before they become infected.
Degrees to lessen your chances
– basic hygienic practices (washing
hands),
– keep all wounds clean,
– watch for signs of infection
(increase pain, swelling, pus, heat
or fever),
– seek immediate medical attention
if have symptoms of flesh-eating
disease, and
– have precaution if in close contact
with someone with the bacteria.