Necrotizing Fasciitis

What It Is

• Polymicrobial soft-tissue infection that travels rapidly along fascial planes - can
be both limb and life threatening.

Why It’s an Emergency

• This is an extremely rapidly progressive infection that can spread on the order
of hours.

How “Emergent” Is It?

• Emergent. Untreated it can progress to limb-threatening or life-threatening

extent within hours.

When to Be Suspicious

• Rapidly progressive soft-tissue infection

° Often minimal erythema (infection spreads faster than immune system can
respond with inflammation)
° “Dirty dishwater” drainage
° Subcutaneous crepitus

© Springer International Publishing Switzerland 2017 25

M.C. Makhni et al. (eds.), Orthopedic Emergencies,
DOI 10.1007/978-3-319-31524-9_8
26 J. Shillingford

Fig. 1 Necrotizing fasciitis around the elbow

How to Diagnose

• Clinical diagnosis—no lab or imaging work-up definitive

• Emergent frozen section in OR can be confirm diagnosis, but shouldn’t delay
treatment (Fig. 1)

How to Treat

• Emergent fasciotomy/radical debridement and I+D, often requiring wide mar-

gins of soft-tissue excision

° Broad-spectrum antibiotics after I+D

• Consider amputation when infection is life threatening

References

Bellapianta JM, Ljungquist K, Tobin E, Uhl R. Necrotizing fasciitis. J Am Acad Orthop Surg.
2009;17(3):174–82.
Ozalay M, Ozkoc G, Akpinar S, Hersekli MA, Tandogan RN. Necrotizing soft-tissue infection
of a limb: clinical presentation and factors related to mortality. Foot Ankle Int.
2006;27(8):598–605.