Necrotizing Fasciitis

Necrotizing fasciitis is a rare but extremely serious bacterial infection that spreads rapidly along the tissue layers beneath the skin, destroying tissue and threatening life. It is a surgical emergency requiring immediate treatment.

• Severe pain, often out of proportion to how the skin initially looks
• Rapidly spreading redness and swelling, sometimes with a purplish or blistering appearance as it progresses
• Fever and feeling extremely unwell
• Skin that may become discoloured, blistered, or develop areas of dead tissue (necrosis) as the infection advances
• Rapid deterioration and signs of sepsis or shock

• Caused by bacteria (often a combination of organisms, sometimes including group A Streptococcus) entering through a break in the skin, such as a wound, surgical site, or, occasionally, without any obvious entry point.
• Risk is increased by diabetes, weakened immunity, obesity, and any wound or skin injury, though it can occasionally occur in otherwise healthy people.

• Suspected clinically based on rapidly worsening, severe pain and spreading skin changes that seem disproportionate to the visible findings, together with fever and a rapidly deteriorating clinical picture.
• Urgent surgical exploration is often both diagnostic and the first step in treatment, since imaging or laboratory tests can delay the critical early intervention needed.

Necrotizing fasciitis is a surgical emergency; urgent, often extensive, surgical removal of infected and dead tissue is the cornerstone of treatment and is required as soon as possible once suspected.

Broad-spectrum intravenous antibiotics are started immediately alongside surgical planning, covering the range of possible causative bacteria.

Intensive supportive care is usually needed, including careful fluid management and monitoring for or treatment of septic shock.

Repeated surgical procedures are often required over the following days to ensure all infected tissue has been removed, and reconstructive surgery may be needed once the infection is controlled.

• Keep wounds clean and seek prompt medical care for any wound that is unusually painful, rapidly worsening, or associated with fever.
• Manage underlying conditions such as diabetes well, as they increase risk.
• Seek immediate emergency care for pain that seems far more severe than the visible skin appearance would suggest, together with rapid spread of redness or swelling.