Necrotizing fasciitis
◼️This is a surgical emergency, most commonly caused by a synergistic polymicrobial infection that usually involve Group A beta hemolytic streptococci, along with S.Aureus, E.coli, Proteus, Clostridia and others.
◼️The infection spreads very rapidly along fascial planes (figure above demonstrate extent of progression in 24 hour period), it may affect abdominal wall (Meleney's gangrene) or perineum (Fournier gangrene) but it most commonly involve lower limbs.
◼️This is a clinical diagnosis, there is edema stretching beyond the extent of visible erythema, there is WOODY HARD feel to the subcutaneous tissues, inability to distinguish muscle groups on palpation, there is severe pain out of proportion to the visible lesion, with soft tissue crepitus, overlying skin may show vesicles, dusky blue or black discoloration and frank necrosis.
◼️Systemic features are outstanding, with rapidly progressing septic shock.