Diagnosis of Necrotizing Fasciitis & Treatment

Diagnosis of necrotizing fasciitis (NF) can prove extremely challenging. The condition has many of the same characteristics as cellulitis, and is often diagnosed incorrectly as such.(1) The resulting delay in implementing appropriate treatment can prove catastrophic in such a rapidly progressing condition.

Cellulitis or Necrotizing Fasciitis?

One key differentiator between NF and cellulitis  is the higher intensity of pain experienced by patients with NF.(1,2)  Excessive pain should therefore raise the possibility of NF to the healthcare professional. Early symptoms of minor wound trauma, flu-like symptoms, and dehydration yield rapidly over the course of 3 to 4 days to advanced symptoms including hemorrhagic bullae,(3) wound necrosis, severe hypotension, and even unconsciousness.(2)  

Tissue Biopsy

The gold-standard method for confirming diagnosis of NF includes wound exploration and tissue biopsy. During wound exploration, tissue integrity and depth of invasion can also be evaluated.(1) Laboratory tests should also be performed routinely to investigate possible organ dysfunction.(3)

Treatment of Necrotizing Fasciitis

Following confirmed diagnosis of necrotizing fasciitis, it is critical to implement management strategies immediately. The mainstay of NF treatment includes a combination of surgical debridement, broad-spectrum antibiotics, and hyperbaric oxygen therapy to improve oxygenation of infected areas.(2) Initial surgery in the form of aggressive and extensive debridement is the most important determinant for survival, and patients may require anything up to 40 sessions of surgery to remove all evidence of infection.(3) Appropriate choice of antibiotics is also important, and the initial approach should include agents effective against aerobic Gram-positive cocci, Gram-negative  rods,  and  anaerobes.(1)  A  combination  of  penicillin  and  clindamycin usually underpins the antibiotic regimen of choice.(1) Supportive treatment such as hemodynamic support, wound care, and nutritional support are also essential to reduce morbidity and mortality in NF.(3)

Recognizing the Signs of NF – Necrotizing Fasciitis

In NF, the actions of the wound care specialist can have a dramatic effect not only on patient morbidity but even on patient survival. It is essential that the wound care specialist recognizes the signs of NF, realizes a confirmed diagnosis, and implements effective management strategies rapidly. Studying for further professional qualifications may give a wound care professional the knowledge to manage complex conditions such as NF with greater confidence.

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References

1. Cheung JPY, Fung B, Tang WM, Ip WY. A review of necrotising fasciitis in the extremities. Hong Kong Med J 2009; 15: 44-52
2. Taviloglu K and H Yanar. Necrotizing fasciitis: strategies for diagnosis and management. World J Emerg Surg 2007; 2:19
3. Shimizu T and Tokuda Y. Necrotizing fasciitis. Inter Med 2010; 49: 1051-1057