Management of Necrotizing Fasciitis

There are four general principles that guide the management of a necrotizing soft-tissue infection: (1) early identification, (2) source control, (3) antibiotics, and (4) supportive care. Early identification of a serious necrotizing soft-tissue infection may not be straightforward. The typical signs are erythema, purplish discoloration of the skin with bullae, edema, crepitus, and pain that seems disproportionate to the findings on examination. Since in many cases, not all these signs are present, practitioners may underestimate the extent of the disease process. Surgical control of the source of the infection is a lifesaving maneuver. Because of this, emphasis is placed on removing affected tissue, regardless of possible resultant cosmetic defects. Removal of the necrotic tissue and the bacterial load allows antibiotics to control the spread of bacteria more effectively. Because of the rapidity with which necrotizing fasciitis spreads, time is of the essence when dealing with source control. Despite early aggressive surgical débridement, mortality rates range from 16 to 45%.

New England Journal of Medicine - Vol. 361, No. 17, October 22, 2009