Necrotizing Fasciitis

1
Necrotizing Fasciitis

• By
• Dr.Hanaa Tashkandi

2
Necrotizing Fascitiis

• Definition
• Risk factors
• Etiology
• Pathophysiology
• Epidemiology
• Clinical Features
• Investigations
• Management

3
Diffuse Necrotizing Infection(flesh-eating)

• DangerousWhy?

4

• Difficult to diagnose
• Extremely toxic
• Spread rapidly
• May lead to limb amputation

5
Classification

• _at_ Colistridial
• Necrotizing cellulitis
• Myositis
• _at_ Non-colistridial
• NECROTIZING FASCIITIS
• Streptococcal gangrene
  

6
Necrotizing Fasciitis

• It is a progressive, rapidly spreading,
  inflammatory infection located in the deep fascia
  with 2ry necrosis of the subcutaneous tissue.

7
Risk Factors

• Immunocompression illnesses
• e.g. DM, Cancer, alcoholism, vascular
  insufficiency, organ transplant, HIV or
  neutropenia.
• Trauma or foreign bodies in surgical wound.
• Idiopathic as scrotal or penile necrotizing
  fasciitis.

8
Causative Agents

• It is a mixed microbial flora
• microaerophilic streptococci.
• staphylococci.
• aerobic gram ve
• anaerobes ( peptostreptococi
• bacteroids)

9
Pathophysiology
10
Mortality Morbidity

• The overall morbidity mortality is 70 80
• Fourniers gangrene has a reported mortality as
  high as 75

11

• Sex Male Female 31
• Age
• the mean age is 38 to 44
  years.
• pediatric cases are rare but
• reported from countries where
  
• poor hygiene in.

12
Clinical Features

• Symptoms
• sudden onset of pain and swelling at
  the site of trauma or recent surgery.
• in some cases, the symptoms may begin
  at the site distant from the initial traumatic
  insult.
• Fournier's gangrene begin with pain
  and itching of the scrotal skin.

13
Clinical Features (cont.)

• Sings
• pt. appears moderately to severely
  toxic (but sometimes might looks well)
• typically, erythema that quickly
  spread over a course of hours to days.
• the redness quickly spread the
  margin of infection move out into normal skin
  without being raised nor sharply demarcated.
• anesthesia
• Note
• I.M. injections I.V. infusions may lead to
  necrotizing fasciitis.
• minors insect bites may set the stage for
  necrotizing infections.

14
(No Transcript)
15
(No Transcript)
16
Investigations

• Lab CBC, UE, Glu, Creatinine, Blood
• tissue cultures, Urine analysis,
• ABG.

17
Investigations (cont.)

• Imaging Studies
• X-ray ? gas in the subcutaneous
• fascia planes.
• ?? D.D. of subcutaneous gas in a
• radiograph.
• C.T. ? demonstrating necrosis with
• asymmetric fascial
  thickening
• gas in the tissues.
• MRI.

18
(No Transcript)
19
Investigations (cont.)

• Microbiology
• Gram stain wound culture
• Procedures
• Biopsy is the best method to use to obtain
• proper cultures for micro-organisms.

20

21
Emergency Department care

• A
• B
• C
• D

22
Management

• If streptococci are the identified major
  pathogens, the D.O.C is Penicillin-G with
  clindamycin as an alternative.
• To ensure adequate treatment, we have to cover
  aerobic anaerobic bacteria.
• The anaerobic coverage can be provided by
  Metronidazole or 3rd generation cephalosporin's.

23
Management (cont.)

• Gentamicine combined with clindamycine or
  chloramphenicol has been reported as a standard
  coverage.
• Ampicilline may be added to the basic regimen to
  treat enterococci if suspected by gram stain.

24
Further In-Patient Care

• Surgical debridment.
• Fasciotomy.
• H.B.O.

25
Complications

• Renal Failure.
• Septic Shock with cardiovascular collapse.
• Scarring with cosmetic deformity.

26
Medico-legal Pitfalls

• Early in the course of the disease, necrotizing
  fasciitis may appear quiet benign.
• Be wary of the patient with pain out of the
  proportion to physical finding.

27

• THANK YOU
• Hanaa Tashkandi