Necrotizing fasciitis is a rare, but harmful soft tissue disorder connected with microbial infections and leading to necrosis of the structural part and underlying flesh of the skin. Indications of necrotizing fasciitis go back to the 5th century BC.
In somewhat more modern times, Joseph Jones, an army physician in the American Civil War, detailed 2642 incidents of what he called ‘hospital gangrene’ which had a recorded death rate of 50%.
Necrotizing fasciitis around the genitalia was first recorded by a researcher named Baurienne in 1764 and is called Fournier’s gangrene after Jean Alfred Fournier who presented five cases for lectures in 1883. In 1952, the disease was formally named ‘necrotizing fasciitis’.
The general public may know necrotizing fasciitis as ‘flesh-eating bacteria’ and ‘killer bug’, phrases often used by reporters and news people.
Symptoms of Necrotizing Faciitis
Necrotizing fasciitis can occur in any part of the body but it is most common in the truncal region, genitals, legs, and other extremities.
Most research shows that necrotizing fasciitis occurs as a result of minor trauma or surgery to the affected area. Usually there is some prior history like an cut, or an insect bite. But, in some cases (10%-40%), there is no prior wound.
Necrotizing fasciitis can occur in any age group but is more common in men associated with an underlying condition. Older age is a factor in susceptibility to necrotizing fasciitis, but the estimated age at which occurrences becomes more frequent is between 60 and 65 years of age.
Disproportionate pain combined in the infected is the leading symptom along with deep redness and swelling. Flu-like or signals that appear to be cellulitis are frequent as well.
It may be the only sign is blistering and oozing which occurs in about 30% of cases. As the infection progresses, the skin goes from a red purple color to dusky blue, and other colors as the infection and necrosis continues to destroy skin cells. Oftentimes, the large pus blisters surrounded by dead tissue are reported.
Treatment of Necrotizing Faciitis
A range of antibiotics is recommended immediately upon diagnosis. The combination of clindamycin and cefuroxime should be administered, and have recently been accepted as the common treatment for patients in the hospital.
Researchers believe that antibiotic therapy should be continued until there is no further need for surgical removal of dead skin and the patient has stabilized. Usually that takes between 10–14 days.
Surgical debridement (removal of dead tissue) is critical in fighting necrotizing fasciitis and is essential to stop the progression of the disease. The non-viable tissue should be removed leaving a wide band of viable tis-sue to reduce the risk of recurrence. A ‘dull murky dishwater fluid’ may be found in the wound, which is a characteristic of necrotizing fasciitis.
The patient should be taken to surgery immediately and surgeons should make incisions into the flesh and remove all non-viable tissue. A former practice of ‘sparing of muscle’, is now replaced by the concept of removal of all non-viable tissue, including muscle if necessary.
Further surgical exploration may be considered after 24-48 hours, to examine the wound and to ensure the infection has stopped. Hemorrhage is not uncommon after removing dead tissue; therefore whole blood and clotting products should be available before surgery.
Amputation is necessary in some cases of necrotizing fasciitis when muscle groups are dead, resulting in the loss of use of extremities. If necrotizing fasciitis affects the genital area then a temporary colostomy should be considered to reduce stress on the patient.
Following surgery, normal wound healing may be difficult in patients with necrotizing fasciitis due to the nature of the disease and any underlying conditions. The wound could take several months to heal, and would heal through granulation and scar tissue formation. Grafting of skin is recommended after the wound has healed.
There are several new technologies to support people recovering from the wounds from necrotizing fasciitis including life-like covers that disguise scar tissue and areas of reduced flesh and muscle mass.