Episode 204: Necrotizing Fasciitis

We discuss the recognition and treatment of necrotizing fasciitis.
Hosts:
Aurnee Rahman, MD
Brian Gilberti, MD



https://media.blubrry.com/coreem/content.blubrry.com/coreem/Necrotizing_Fasciitis.mp3



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Tags: Critical Care, General Surgery





Show Notes
Table of Contents
0:00 – Introduction
0:41 – Overview
1:10 – Types of Necrotizing Fasciitis
2:21 – Pathophysiology & Risk Factors
3:16 – Clinical Presentation
4:06 – Diagnosis
5:37 – Treatment
7:09 – Prognosis and Recovery
7:37 – Take Home points

Introduction

* Necrotizing soft tissue infections can be easily missed in routine cases of soft tissue infection.
* High mortality and morbidity underscore the need for vigilance.

Definition

* A rapidly progressive, life-threatening infection of the deep soft tissues.
* Involves fascia and subcutaneous fat, causing fulminant tissue destruction.
* High mortality often due to delayed recognition and treatment.

Types of Necrotizing Fasciitis

* Type I (Polymicrobial)

* Involves aerobic and anaerobic organisms (e.g., Bacteroides, Clostridium, Peptostreptococcus).
* Common in immunocompromised patients or those with comorbidities (e.g., diabetes, peripheral vascular disease).


* Type II (Monomicrobial)

* Often caused by Group A Streptococcus (Strep pyogenes) or Staphylococcus aureus.
* Can occur in otherwise healthy individuals.
* Vibrio vulnificus (associated with water exposure) is another example.


* Fournier’s Gangrene (Subset)

* Specific to perineal, genital, and perianal regions.
* Common in diabetic patients.
* Higher mortality, especially in females.



Pathophysiology

* Spread Along Fascia

* Poor blood supply in fascial planes allows infection to advance rapidly.
* Tissue ischemia worsened by vascular thrombosis → rapid necrosis.


* High-Risk Patients

* Diabetes with vascular compromise.
* Recent surgeries or trauma (introducing bacteria into deep tissue).
* Immunosuppression (e.g., cirrhosis, malignancy, or immunosuppressive meds).
* NSAID use may mask symptoms, delaying diagnosis.



Clinical Presentation
Early Signs & Symptoms

* Severe Pain out of proportion to exam findings.
* Erythema (often with indistinct borders).
* Fever, Malaise (systemic signs of infection).
* Rapid progression with possible color changes (red → purple).
* Bullae Formation (fluid-filled blisters) and skin necrosis/gangrene.
* Crepitus in polymicrobial cases (gas production in tissue).

Late-Stage Signs