Necrotizing Fasciitis

Epidemiology and Etiology:

· Progressive, rapidly spreading inflammatory infection in the deep fascia

· Secondary necrosis of subcutaneous tissues

· Aerobic, anaerobic, or mixed flora

· Streptococcus pyogenes (GAS)

· Staphylococcus aureus

· Bacteroides

· Clostridium perfringes

· Peptostreptococcus

· Enterobacteriaceae

· Coliforms

· Proteus

· Pseudomonas

· Klebsiella

· Immunocompromised

· Diabetes

· Cancer

· Alcoholism

· Vascular insufficiencies

· Organ transplants

· HIV

· Neutropenia

· Local tissue hypoxia

· Trauma

· Surgery

· Injections and infusion sites

· Around foreign bodies in surgical wounds

· idiopathic

Common sites:

· Fournier gangrene - scrotum

Gross features:

· Erythema superficially

· Massive undermining of the skin and subcutaneous layer

· Yellowish-green necrotic fascia

· Subcutaneous air often

· Maybe only visible on radiographs

· Secondary involvement of deeper muscle layers maybe

Histologic features:

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Immunophenotype:

Marker:

Sensitivity:

Specificity:

Molecular features:

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Other features:

· High morbidity and mortality (70-80%)

· 30-40% mortality rate

References:

· E-medicine.medscape.com

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