Necrotizing fasciitis is an infection of the deep soft tissues that result in progressive destruction of the muscle fascia and the overlying subcutaneous fat. This condition is notorious for rapid progression. Early and aggressive surgical debridement and treatment with appropriate antibiotics are important to reduce mortality.
LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) Score (>6 favours NF):
| Parameter | Units | Score |
|---|---|---|
CRP |
mg/dL |
|
<15 |
|
0 |
≥15 |
|
4 |
|
||
WBC |
cells/mm3 |
|
<15000 |
|
0 |
15000-25000 |
|
1 |
>25000 |
|
2 |
|
||
Hemoglobin |
g/dL |
|
>13.5 |
|
0 |
11-13.5 |
|
1 |
<11 |
|
2 |
|
||
Sodium |
mmol/dL |
|
≥135 |
|
0 |
<135 |
|
2 |
|
||
Creatinine |
mg/dL |
|
≤1.6 |
|
0 |
>1.6 |
|
2 |
|
||
Glucose |
mg/dL |
|
≤180 |
|
0 |
>180 |
|
1 |
Table 6.3: Clinical signs which favour NF>cellulitis
| Symptoms | General examination |
|---|---|
High grade fever |
Toxic look |
Delirium |
Hypotension |
Lethargy |
Tachycardia |
Severe pain disproportionate to clinical signs |
Pallor |
Limb examination |
|
Skip areas (Areas of normal skin surrounded by infection) |
Edema/tenderness extending beyond the cutaneous erythema |
Dishwater-like pus discharge |
Probe sign* positive |
Hypoesthesia over the skin |
Bullous lesions |
Crepitus |
Skin necrosis/ecchymoses |
Wooden hard induration of subcutaneous tissue extending beyond the area of apparent skin involvement |
|
*: After infiltrating the involved area, a 2 cm incision is made down to the deep fascia. Gentle probing is performed with a blunt instrument or index finger and if the tissue dissects with minimal resistance, then probe test is considered to be positive.