Necrotizing Fasciitis - Everything You Need To Know - Dr. Nabil Ebraheim

Video Description

Educational video describing the condition and treatment known as necrotizing fasciitis / flesh eating infection.
Necrotizing fasciitis is a catastrophic infection problem that can lead to amputation or death. Necrotizing fasciitis will have a better outcome if it is recognized early and treated successfully. It presents itself as a cellulitis case and confuses health care professionals. Necrotizing fasciitis can spread rapidly and the condition of the patient can deteriorate even though the patient is in the hospital under the care of physicians. By the time we figure it out, It may be too late.
A small incision can be made over the involved area in the clinic or the emergency room, with direct inspection of the fascia and the muscles. This may differentiate between necrotizing fasciitis and cellulitis.
A culture is usually obtained to determine the species of bacteria present within the wound. The gram stain may show gram-positive cocci in chains (group A streptococci) or polymicrobial.
Necrotizing fasciitis, commonly known as flesh-eating, is a limb and a life threatening soft tissue infection. The bacteria produce toxins and spreads rapidly. There is also an association between hepatitis C and Necrotizing fasciitis.
Early diagnosis and adequate treatment are important to save the limb or the life.
Usually occurs after a minor trauma. May be associated with chronic disease and illness.Usually found in alcoholics, diabetics, insect bites, or post surgery infections.
The mortatlity rate is 33%.
It is underdiagnosed because it resembles low-grade cellulitis.
Surgical debridement should be urgent. Delay in surgery more than 24 hours is associated with increased mortality.
Diagnosis
•Pain
•Tenderness beyond apparent margin of infection is diagnostic and found in 98% of cases. Group A strep and other polymicrobial infections involve the fascia and the toxins spread.
Other findings:
•Erythema 110%
•Bullae formation less than 50%
•Crepitus 14%
•Skin necrosis 14%
•Tachycardia 75%
•Fever 50%
•Low blood pressure (hypotension) 18%
Early diagnosis is important:
•Aggressive and extensive debridement of the affected area.
•Obtain a biopsy from the periphery.
Treatment
•Debridement should be repeated on almost daily basis.
•Antibiotics (According to culture results)
•Hyperbaric oxygen (good results for clostridial myonecrosis)
•There is high incidence of extremity amputation if fascia is penetrated by infection.