Necrotizing Fasciitis

Necrotizing fasciitis requires prompt diagnosis and treatment to minimize morbidity and mortality. However, there is frequently a delay in diagnosis. The process can be polymicrobial, or secondary to one pathogen, such as Group A beta-hemolytic Streptococcus in healthy patients, and more rarely gram-negative bacteria. The bacteria’s primary site of infection is the superficial fascia with delayed onset of thrombosis of vessels. Overlying skin necrosis is a late finding. A key clinical clue may be disproportionate pain compared to physical findings. Subcutaneous gas is not a common presentation. The infection progresses rapidly over hours or days with skin breakdown and bullae. Early recognition is critical because early debridement is required, and antibiotics alone are not sufficient.