diagnosis
Last reviewed 01/2018
The diagnosis of necrotising fasciitis is overridingly clinical. There must be low threshold for diagnosis if the following features are present:
- skin changes:
- erythema
- low-grade cellulitis
- cyanotic discolouration or ecchymosis
- epidermolysis or bullae
- skin necrosis
- anaesthesia of skin beyond the margin of surface colour change
- crepitus
- a hard, indurated feel to the subcutaneous tissue which is present beyond the visible limits of skin involvement
- pain out of proportion to the visible surface changes
- signs of systemic toxicity with altered mental status, fever, shock or acute renal failure
- minimal improvement despite initial antibiotic therapy
A number of blood investigations may support the diagnosis. Imaging should not delay the patient progressing to theatre for rapid, adequate debridement.
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