Subcutaneous infection and necrotizing fasciitis of the limbs in adults; surgical treatment.

We report the clinical aspect of subcutaneous cellular tissue streptococcal necrosis. These dramatic infections have 2 clinical aspects: superficial a nd deep. The hypodermic tissue necrosis is limited and does not affect the fascia. it is caused by the thrombosis of local vessels and is followed by skin necrosis. Necrotizing fasciitis is more dramatic and much less frequen t. Anatomic pathophysiology concerns the soft tissue surrounding the fascia . A Streptococcus is involved in most of the cases for both diseases, even if this is difficult to demonstrate. Surgery is suggested after a short the rapeutic test, if erythema does not regress after a few hours of penicillin -therapy; Surgery consists in excision of all the necrotic tissue. Deep nec rotizing fasciitis calls fora really dramatic surgery with a high level of mortality and heavy functional sequels. (C) 2000 Editions scientifiques et medicales Elsevier SAS.