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Skin infections

Skin infections

Necrotising Fascitis

Break in skin with water contact/immuno-compromised patient...

Types of Necro Fas

  1. Polymicrobial
  2. Mono-microbial[strep pyogenes/MRSA]
  3. Vibrio vulnificus
  4. Fungal infection in immuno-compromised

Patho-physiology

  • either by contact in skin opening / perforated bowel
  • ischemic region promotes 1 inch/h spread
  • in Polymicrobial . the Faculatative gram negatives ,helps anearobes to grow
  • Aneorbic inhibits phogocytosis , which helps aeorbic growth
  • The alpha-toxin produced by the Clostridium species causes tissue necrosis and cardiovascular collapse.
  • S. aureus and streptococci produce exotoxins and cause the release of tumor necrosis factor and cytokines that can produce the systemic inflammatory response syndrome and lead to septic shock, organ failure, and death.

Symptoms of Nerotising fascitis

  • severe pain , non supportive of gross presentation
  • some might be parasthetic in the affected region
  • anxiety
  • diaphoresis
  • brawny edema & Crepitus by gas production

Diagnose Necrotising fascitis

no single test or sign that can reliably confirm the early diagnosis of necrotizing fasciitis - tenderness beyond the area of erythema - *Bullae with Crpts mostly Necrotising Fascitis* alt text

  • Laboratory and Imaging Results Associated With Necrotizing Fasciitis/LRINEC score
  • LRINCE maybe low in Vibro facsitis alt text
  • imaging alt text - Non contrast CT with gas gangrene - alt text - Xray of Necro fas - alt text - alt text

Mng of Necrotising Fascilitis

  • Tissue ischemia impeeds immune function
  • So Anti-biotics does not help clear completly
  • aggressive fluid resuscitation/ PRBC transfusion*

Avoid vasoconstrictors

if at all possible, because vasoconstrictors will decrease perfusion to already ischemic tissue.

  • Surgical mangment is Gold Standard
    • fasciotomy/debridement, and/or amputation.
    • Mortality skyrockets if debridement is delayed >24 hours