From the Guidelines
The most sure sign of necrotising soft tissue infection is the presence of skin necrosis with easy dissection along the fascia by a blunt instrument, or the presence of gas in the soft tissues, as these signs indicate severe tissue damage and are highly suggestive of necrotizing fasciitis. According to the 2014 update by the Infectious Diseases Society of America 1, features suggestive of necrotizing fasciitis include skin necrosis and the presence of gas in the soft tissues, which are more specific and reliable indicators of necrotizing soft tissue infection than grayish brown discharge from the wound, fever, or redness, pain, and pitting edema with fever. While grayish brown discharge from the wound can be a sign of tissue necrosis, it is not as specific or reliable as skin necrosis or gas in the soft tissues, which are more definitive indicators of necrotizing fasciitis. The presence of these signs should prompt immediate surgical evaluation and intervention, as necrotising soft tissue infections are surgical emergencies requiring prompt debridement to prevent rapid spread and potentially fatal outcomes. Key features of necrotizing fasciitis include:
- Skin necrosis with easy dissection along the fascia by a blunt instrument
- Presence of gas in the soft tissues
- Profound toxicity, fever, hypotension, or advancement of the soft tissue infection during antibiotic therapy
- Failure of apparently uncomplicated cellulitis to respond to antibiotics after a reasonable trial.
From the Research
Signs of Necrotising Soft Tissue Infection
The most sure sign of necrotising soft tissue infection is not explicitly stated in the provided studies. However, the studies mention the following signs and symptoms:
- Grayish brown discharge from the wound is not mentioned as a specific sign in the provided studies.
- Fever + soft tissue infection is a common presentation, but not the most sure sign 2, 3, 4, 5, 6.
- Redness, pain, pitting oedema with fever are common symptoms, but the studies do not specify that these are the most sure signs 2, 3, 4, 5, 6.
Diagnosis and Treatment
The diagnosis of necrotising soft tissue infections relies on a high index of suspicion, good clinical judgment, and laboratory and imaging studies 5, 6. The treatment requires early, aggressive surgical debridement of all necrotic tissue, appropriate systemic antibiotic therapy, and supportive care to maintain oxygenation and tissue perfusion 2, 3, 4, 5.
Key Factors
Key factors that affect the outcome of necrotising soft tissue infections include:
- Delayed definitive debridement, which remains the single most important risk factor for death 5.
- Prompt administration of potent antimicrobial agents, which is pivotal for successful treatment 3.
- Optimization of the antibiotic treatment strategy, which requires consideration of local epidemiology of causative pathogens and antimicrobial resistance patterns 3.