Necrotizing fasciitis: A plea for early diagnosis and treatment

Introduction: Necrotizing fasciitis is an uncommon infectious entity that p oses difficult diagnostic and therapeutic management decisions. Purpose: This paper addresses the presentation, evaluation and management o f the patient with a necrotizing soft tissue infection. Case Report. A 54-year-old man presented to his physician with pain and swe lling of the left anterior chest wall following a presumed insect bite seve ral days prior. He was treated with oral antibiotics but returned to the of fice three days later with increased swelling. pain, and erythema in the ax illa. Necrotizing fasciitis was diagnosed. He was hospitalized and taken to the operating room for debridement of the chest wall. Extensive necrosis o f the skin, subcutaneous tissue and muscle was encountered. Muscle debridem ent extended from the pectoralis major and both obliques anteriorly to the latissimus dorsi and para-spinalis muscles posteriorly. Multiple operative debridements were performed over several days. The patient developed septic shock requiring blood pressure support, and multiple organ system failure requiring hemodialysis, prolonged ventilatory support and eventual tracheos tomy. Split-thickness skin grafts were placed during the third operative de bridement and concluded on the 15th day of hospitalization. The patient eve ntually recovered and on the 53rd hospital day was transferred to the rehab ilitation service, where he spent the next four weeks recovering movement i n the left arm. Conclusion: Necrotizing fasciitis is an infectious entity that requires rap id diagnosis, surgical debridement, and tissue coverage if the patient is t o survive.