Necrotizing Fasciitis

Necrotizing fasciitis is a serious disease that's commonly treated by orthopaedic surgeons. Also known as flesh-eating disease, it's a bacterial infection that spreads quickly and can be deadly.

Flesh-eating bacteria can enter your body through a wound and attack the connective tissue below the skin.

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• What Is Necrotizing Fasciitis?
• What Are the Symptoms of Necrotizing Fasciitis?
• How Do You Diagnose Necrotizing Fasciitis?
• How Do You Treat Necrotizing Fasciitis?

What Is Necrotizing Fasciitis?

Doctors define necrotizing fasciitis (flesh-eating disease) as a bacterial infection that starts below the surface of the skin. The bacteria attack the fascia — the connective tissue below the skin surrounding your muscles and organs.

The infection can start any place there's a break in the skin where bacteria can enter. Flesh-eating disease is very serious, which is why doctors start treatment as soon as they suspect it.

How common is necrotizing fasciitis?

Flesh-eating disease is very rare. It affects about 4 in 1 million Americans every year, according to the National Library of Medicine.

What causes necrotizing fasciitis?

Various types of bacteria cause flesh-eating disease. These bacteria may be present in the environment, such as in bodies of water, or carried by humans.

The most common cause of necrotizing fasciitis is Group A Streptococcus (strep) bacteria, which also causes strep throat. While strep throat from Group A strep is common, it's very rare for any type of bacteria to cause necrotizing fasciitis.

Other types of bacteria that can also cause necrotizing fasciitis include:

• Staphylococcus aureus.
• Escherichia coli (E. Coli).
• Klebsiella.

Often, more than one type of bacteria infects the fascia in flesh-eating disease.

What are necrotizing fasciitis risk factors and complications?

Anyone can get flesh-eating disease — even young, healthy people. But some people are at higher risk.

Necrotizing fasciitis risk factors

You may be at a higher risk of getting flesh-eating disease if you:

• Drink alcohol heavily, which makes it harder for your body to fight infections.
• Have a health issue that weakens your immune system, like cancer or diabetes.
• Have a deep wound from a surgery or injury.
• Use intravenous drugs.

Complications of necrotizing fasciitis

Because flesh-eating bacteria spread quickly throughout the body, it can have severe complications. These include:

• Organ failure.
• The loss of one or more limbs.
• Toxic shock syndrome, caused by a toxin produced by the bacteria.
• Death.

How can I prevent necrotizing fasciitis?

To avoid prevent flesh-eating disease:

• Avoid swimming when you have an open wound from a cut, blister, or other injury.
• Clean wounds with soap and water and cover them with clean bandages or gauze.
• See a doctor if you have a deep wound that reaches the connective tissue under the skin so they can properly clean and close it.
• Wash your hands often.

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What Are the Signs and Symptoms of Necrotizing Fasciitis?

Early symptoms of flesh-eating disease include:

• Fever.
• Intense pain around a wound, after the pain from the initial injury subsides.
• Skin around a wound that feels warm to the touch.
• Swelling and discoloration of skin around a wound that spreads quickly.
• Pain when you touch the nonswollen or red skin around the wound. (This happens because the infection spreads under the skin before signs show up above the skin).
• Popping or cracking sounds when you touch the skin around the wound. (The bacteria produce gas that gets trapped under the skin).

Later symptoms of flesh-eating disease include:

• Blisters or sores on the skin.
• Bluish-gray or black areas on the skin.
• Diarrhea.
• Dizziness.
• Fast heartbeat.
• High fever.
• Reduced pain in the affected area due to nerve damage.

When should I see a doctor about my necrotizing fasciitis symptoms?

Go to the emergency department immediately if you have signs of flesh-eating disease. The main, early symptom is swelling and red or discolored skin that spreads quickly from a wound.

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How Do You Diagnose Necrotizing Fasciitis?

Because this disease only becomes more life-threatening, doctors treat necrotizing fasciitis based on the signs and symptoms, including how the skin looks.

Your doctor will order tests alongside treatment to confirm the diagnosis and guide further treatment.

Tests to diagnose necrotizing fasciitis

As your care team treats your wound, they may order:

• A culture of the fluid around the wound to identify the types of bacteria present. The results of this test can determine which type of antibiotic is best for you.
• A CT scan to look for inflammation under the skin, so they can see how far the infection has spread.
• Blood tests to look for signs of infection, like a high white blood cell count.

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How Do You Treat Necrotizing Fasciitis?

Doctors treat necrotizing fasciitis with surgery and medicine. Many people require multiple surgeries.

Surgery for necrotizing fasciitis

In a procedure called "debridement," the surgeon opens up the skin around the wound. They then remove all dead and infected tissue, along with tissue that may be infected. They thoroughly clean the area.

A debridement requires general anesthesia, meaning you're asleep during the procedure. After surgery, the area is packed with gauze, which health providers will change daily.

Your team will watch the area closely for signs of infection after surgery. They'll do more debridements, as needed. In some cases, surgeons may need to amputate part of a limb to stop the infection from spreading.

Your doctor may take skin and muscle tissue from a more hidden area of your body and attach it to the wound site. This can improve the long-term appearance and function of the affected area. Sometimes the doctor may need to use artificial skin to close the wound.

Antibiotic treatment for necrotizing fasciitis

Your doctor will prescribe IV antibiotics to help ensure the infection doesn't spread to healthy tissues.

Since damage from the bacteria can cut off blood supply, antibiotics don't get to the infected tissue. That is why debridement also is necessary.

Other treatments for necrotizing fasciitis

Your doctor may prescribe intravenous immune globulin (human antibodies), which can help to fight infection. You may also need other medicines to support your lungs, heart, liver, or other organs.

Hyperbaric oxygen, or pressurized oxygen, can speed wound healing. Very ill patients who are being monitored by machines can't easily access hyperbaric oxygen chambers. For this reason, doctors use hyperbaric oxygen for small wounds or later in the treatment course.

How effective is treatment?

Even with treatment, about 1 in 5 people with flesh-eating disease will die from it, according to the CDC. People who survive flesh-eating disease usually have reduced function in the affected area due to the destroyed muscle tissue, nerves, and blood vessels.

The earlier in the course of disease people seek treatment, the better their chance of survival.

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