MANAGEMENT OF CASES OF NECROTISING FASCIITIS- AN INDIAN PERSPECTIVE

Necrotising fasciitis (NF) is a severe potentially life-threatening condition which begins with an innocuous trauma or an insect bite which rapidly progresses to involve a large portion of the limb and if not managed with urgency, then it can result in sepsis and shock. Although NF can occur in any region of the body extremities especially lower limb is the most common site of infection -more prone to injury. Prognosis is poorer in the presence of co-morbidities, such as diabetes mellitus, immunosuppression, chronic alcohol disease, chronic renal failure, and liver cirrhosis.NF is classified into four types, depending infective agent. Most cases are polymicrobial, classed as type I.The clinical status of the patient varies from erythema, swelling, and tenderness in the early stage to skin ischemia with blisters and bullae in the advanced stage of infection. Because the infection is under the subcutaneous tissue and spreads fast the overlying skin may look nearly normal in early stages and the diagnosis may be missed. Hence the condition must be diagnosed clinically. However, in equivocal cases, the diagnosis and severity of the infection can be made with laboratory-based scoring systems. Computed tomography or ultrasonography can be helpful, but definitive diagnosis is attained by exploratory surgery at the infected sites. Management of the infection begins with broad-spectrum antibiotics, but early and aggressive drainage and meticulous surgical and chemical debridement constitute the mainstay of treatment. Negative Pressure Wound Management is helpful combined with continuous cleansing of the wound leads to the formation of granulation tissue with SSG for completion of healing.