NECROTIZING FASCIITIS - CASE-REPORT AND R EVIEW OF THE LITERATURE

Introduction The purpose of this study was to review the literature co ncerning Necrotizing Fasciitis (N.F.) and to discuss a typical case wh ere late diagnosis led to severe consequences. Material and methods A young male patient with no pertinent medical history, progressively de veloped a large swelling of his foot and severe pain 3-4 days followin g a simple contusion. The absence of an entry site lead to local incis ion without microbiological study. The patient developed blistering on the leg, then septic shock necessitating amputation. Discussion N.F. is an infectious necrosis of the sub-cutaneous tissue appearing freque ntly in surgical or post traumatic contexts. Streptococcal origin is c lassical but multibacterial anaerobic infection is more and more frequ ently observed. An entry site is not always found while the affected s ite becomes red, hot and painful. Evolution is extremely rapid with th e appearance of blisters and cutaneous necrotic sites and a severe alt eration in the general condition of the patient. The extent of sub-cut aneous necrosis is larger than the affected area of skin. N.F. is a su rgical emergency. Treatment consists of complete debridement, sometime s very extensive and multilating. High dose intra-venous antibiotic th erapy is necessary while the benefits of hyperbaric therapy are discus sed. Because of the lack of specific clinical signs, diagnosis is diff icult and is often made too late. The rapidity of the evolution shows that vital and functional prognosis is better with early diagnosis and treatment even for patients without associated pathology. The rate of mortality is approximately 50 per cent. Conclusion Better information of practicioners allowing a rapid clinical diagnosis could improve th e prognosis which is still life-threatening in 1994.