Necrotizing fasciitis

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Panu Teeratakulpisarn


           Necrotizing fasciitis is an infection of subcutaneous tissues and fascia, which have continuous aggressive and rapid progression of the disease. The disease is common in Thailand, and common in the extremities, neck, and body.

           Necrotizing fasciitis causes four types of etiology which are post-traumatic, post-operative, idiopathic, and causes by the complication of cutaneous diseases. The bacteriology of disease has three types; polymicrobial, monomicrobial, and microbial from seawater.

           When the pathogen enters subcutaneous tissue, they colonize and cause inflammation. The process results in the necrosis of tissues. The pathognomonic sign is the patient may experience pain out of proportion, local inflammation of the skin, high-grade fever, SIRS, sepsis, and septic shock.

           Treatments of the disease include broad-spectrum antibiotics, aggressive resuscitation, adequate surgical debridement and drainage, post-operative care, wound closure, and rehabilitation, which requires the skill of surgeons.


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Teeratakulpisarn P. Necrotizing fasciitis. SRIMEDJ [Internet]. 2022 Jun. 24 [cited 2022 Oct. 3];37(3):303-12. Available from:
Review Articles


Moet GJ, Jones RN, Biedenbach DJ, Stilwell MG, Fritsche TR. Contemporary causes of skin and soft tissue infections in North America, Latin America, and Europe: Report from the SENTRY Antimicrobial Surveillance Program (1998–2004). Diagn Microbiol Infect Dis 2007;57(1):7–13.

Rajan S. Skin and soft-tissue infections: Classifying and treating a spectrum. Cleve Clin J Med 2012;79(1):57–66.

Descamps V, Aitken J, Lee MartinG. Hippocrates on necrotising fasciitis. Lancet 1994;344(8921):556.

Sarani B, Strong M, Pascual J, Schwab CW. Necrotizing Fasciitis: Current Concepts and Review of the Literature. J Am Coll Surg 2009;208(2):279–88.

Wilson B. Necrotizing fasciitis. Am Surg 1952;18(4):416–31.

Webb HE. Streptococcal Gangrene. Arch Surg 1962;85(6):969.

Kaiser RE, Cerra FB. Progressive necrotizing surgical infections--a unified approach. J Trauma 1981;21(5):349–55.

Anaya DA, Dellinger EP. Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis 2007;44(5):705–10.

Naseer U, Steinbakk M, Blystad H, Caugant DA. Epidemiology of invasive group A streptococcal infections in Norway 2010-2014: A retrospective cohort study. Eur J Clin Microbiol Infect Dis 2016;35(10):1639–48.

Glass GE, Sheil F, Ruston JC, Butler PEM. Necrotising soft tissue infection in a UK metropolitan population. Ann R Coll Surg Engl 2015;97(1):46–51.

Bocking N, Matsumoto C-L, Loewen K, Teatero S, Marchand-Austin A, Gordon J, et al. High Incidence of Invasive Group A Streptococcal Infections in Remote Indigenous Communities in Northwestern Ontario, Canada. Open Forum Infect Dis 2017;4(1):ofw243.

Khamnuan P, Chongruksut W, Jearwattanakanok K, Patumanond J, Tantraworasin A. Necrotizing fasciitis: epidemiology and clinical predictors for amputation. Int J Gen Med 2015;8:195–202.

Childers BJ, Potyondy LD, Nachreiner R, Rogers FR, Childers ER, Oberg KC, et al. Necrotizing fasciitis: a fourteen-year retrospective study of 163 consecutive patients. Am Surg 2002;68(2):109–16.

Salcido RS. Necrotizing fasciitis: reviewing the causes and treatment strategies. Adv Skin Wound Care 2007;20(5):288–93; quiz 294–5.

Dahl PR, Perniciaro C, Holmkvist KA, O’Connor MI, Gibson LE. Fulminant group A streptococcal necrotizing fasciitis: clinical and pathologic findings in 7 patients. J Am Acad Dermatol 2002;47(4):489–92.

Hakkarainen TW, Kopari NM, Pham TN, Evans HL. Necrotizing soft tissue infections: review and current concepts in treatment, systems of care, and outcomes. Curr Probl Surg 2014;51(8):344–62.

Giuliano A, Lewis F, Hadley K, Blaisdell FW. Bacteriology of necrotizing fasciitis. Am J Surg 1977;134(1):52–7.

Elliott D, Kufera JA, Myers RA. The microbiology of necrotizing soft tissue infections. Am J Surg 2000;179(5):361–6.

Cainzos M, Gonzalez-Rodriguez FJ. Necrotizing soft tissue infections. Curr Opin Crit Care. 2007 Aug;13(4):433–9.

Gold WL, Salit IE. Aeromonas hydrophila infections of skin and soft tissue: report of 11 cases and review. Clin Infect Dis 1993;16(1):69–74.

McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. Determinants of mortality for necrotizing soft-tissue infections. Ann Surg 1995;221(5):558–63; discussion 563-565.

Haywood CT, McGeer A, Low DE. Clinical experience with 20 cases of group A streptococcus necrotizing fasciitis and myonecrosis: 1995 to 1997. Plast Reconstr Surg 1999;103(6):1567–73.

Howard RJ, Pessa ME, Brennaman BH, Ramphal R. Necrotizing soft-tissue infections caused by marine vibrios. Surgery 1985;98(1):126–30.

Stevens DL, Bryant AE. Necrotizing Soft-Tissue Infections. N Engl J Med 2017;377(23):2253–65.

Lancerotto L, Tocco I, Salmaso R, Vindigni V, Bassetto F. Necrotizing fasciitis: classification, diagnosis, and management. J Trauma Acute Care Surg 2012;72(3):560–6.

Andreasen TJ, Green SD, Childers BJ. Massive infectious soft-tissue injury: diagnosis and management of necrotizing fasciitis and purpura fulminans. Plast Reconstr Surg 2001;107(4):1025–35.

Low DE, McGeer A. Skin and soft tissue infection: necrotizing fasciitis. Curr Opin Infect Dis 1998;11(2):119–23.

Davies HD. Flesh-eating disease: A note on necrotizing fasciitis. Can J Infect Dis 2001;12(3):136–40.

Wong C-H, Chang H-C, Pasupathy S, Khin L-W, Tan J-L, Low C-O. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am 2003;85(8):1454–60.

Sikora CA, Spielman J, Macdonald K, Tyrrell GJ, Embil JM. Necrotizing fasciitis resulting from human bites: A report of two cases of disease caused by group A streptococcus. Can J Infect Dis Med Microbiol 2005;16(4):221–4.

Green RJ, Dafoe DC, Raffin TA. Necrotizing fasciitis. Chest 1996;110(1):219–29.

Tsai YH, Huang TJ, Hsu RWW, Weng YJ, Hsu WH, Huang KC, et al. Necrotizing soft-tissue infections and primary sepsis caused by Vibrio vulnificus and Vibrio cholerae non-O1. J Trauma. 2009;66(3):899–905.

Wang YS, Wong CH, Tay YK. Staging of necrotizing fasciitis based on the evolving cutaneous features. Int J Dermatol 2007;46(10):1036–41.

Joshy S, Haidar SG, Iossifidis A. Necrotising fasciitis of the shoulder following muscular strain. Int J Clin Pract. 2006 Jul;60(7):856–7.

Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med 2004;32(7):1535–41.

Holland MJ. Application of the Laboratory Risk Indicator in Necrotising Fasciitis (LRINEC) score to patients in a tropical tertiary referral centre. Anaesth Intensive Care 2009;37(4):588–92.

Su YC, Chen HW, Hong YC, Chen CT, Hsiao CT, Chen IC. Laboratory risk indicator for necrotizing fasciitis score and the outcomes. ANZ J Surg 2008;78(11):968–72.

Edlich RF, Cross CL, Dahlstrom JJ, Long WB. Modern concepts of the diagnosis and treatment of necrotizing fasciitis. J Emerg Med 2010;39(2):261–5.

Nichols RL, Smith JW. Gas in the wound: what does it mean? Surg Clin North Am 1975;55(6):1289–96.

Chao HC, Kong MS, Lin TY. Diagnosis of necrotizing fasciitis in children. J Ultrasound Med 1999;18(4):277–81.

Yen ZS, Wang HP, Ma HM, Chen SC, Chen WJ. Ultrasonographic screening of clinically-suspected necrotizing fasciitis. Acad Emerg Med 2002;9(12):1448–51.

Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, Machairas A. Current concepts in the management of necrotizing fasciitis. Front Surg 2014;1:36.

Lille ST, Sato TT, Engrav LH, Foy H, Jurkovich GJ. Necrotizing soft tissue infections: obstacles in diagnosis. J Am Coll Surg 1996;182(1):7–11.

Mulla ZD. Treatment options in the management of necrotising fasciitis caused by Group A Streptococcus. Expert Opin Pharmacothe. 2004;5(8):1695–700.

Norrby-Teglund A, Muller MP, Mcgeer A, Gan BS, Guru V, Bohnen J, et al. Successful management of severe group A streptococcal soft tissue infections using an aggressive medical regimen including intravenous polyspecific immunoglobulin together with a conservative surgical approach. Scand J Infect Dis 2005;37(3):166–72.

Kaul R, McGeer A, Norrby-Teglund A, Kotb M, Schwartz B, O’Rourke K, et al. Intravenous immunoglobulin therapy for streptococcal toxic shock syndrome--a comparative observational study. The Canadian Streptococcal Study Group. Clin Infect Dis 1999;28(4):800–7.

Bilton BD, Zibari GB, McMillan RW, Aultman DF, Dunn G, McDonald JC. Aggressive surgical management of necrotizing fasciitis serves to decrease mortality: a retrospective study. Am Surg 1998;64(5):397–400; discussion 400-401.

Voros D, Pissiotis C, Georgantas D, Katsaragakis S, Antoniou S, Papadimitriou J. Role of early and extensive surgery in the treatment of severe necrotizing soft tissue infection. Br J Surg 1993;80(9):1190–1.

Callahan TE, Schecter WP, Horn JK. Necrotizing soft tissue infection masquerading as cutaneous abcess following illicit drug injection. Arch Surg 1998;133(8):812–7; discussion 817-819.

Luca-Harari B, Ekelund K, van der Linden M, Staum-Kaltoft M, Hammerum AM, Jasir A. Clinical and epidemiological aspects of invasive Streptococcus pyogenes infections in Denmark during 2003 and 2004. J Clin Microbiol 2008;46(1):79–86.