Necrotizing Fasciitis

Necrotizing Fasciitis

• is a clinical diagnosis with corroborative operative findings
• Operative Findings:
  
  1. Grayish Necrotic Fascia
  2. Lack of resistance of normally adherent superficial fascia to blunt dissection
  3. Lack of bleeding during dissection
  4. Foul Smelling "dishwater" pus
     
     
• Stages: (Wong and Wang)
  
  1. Stage 1: Early (?Cellulitis)
     - tenderness, may extend beyond apparent skin involvement
     - Warm, Erythema, Swelling
  2. Stage 2: Intermediate
     - Blister/Bullae with serous fluid, fluctuance, induration
  3. Stage 3:
     - hemorrhagic bullae
     - anesthesia
     - crepitus
     - necrosis with dusky discoloration to frank gangrene
     
     
• Treatment:
  - Treat for sepsis/septic shock: IV fluids
  - proposed: Ceftazidime 2g, Clindamycin 300mg, Gentamycin 120mg
  - Operative treatment!
  

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