Massive infectious soft tissue injury: diagnosis and management ofnecrotizing fasciitis

Necrotizing fasciitis is a destructive invasive infection of the skin, subcutaneous tissue and deep fascia with relative sparing of muscle. Streptococcal gangrene, progressive bacterial synergistic gangrene (Meleney’s gangrene)1, Fournier’s gangrene and synergistic narcotizing cellulitis all present with extensive skin and soft tissue destruction requiring wide debridement, long term antibiotic therapy and treatment of multi system dysfunction and eventual reconstruction. All these processes have unique characteristics but are commonly considered variations of necrotizing fasciitis. Necrotizing infections, although easily diagnosed, usually require operative debridement in conjunction with antibiotic therapy. Understanding the natural history and unique characteristics of these processes is essential for effective surgical management and favorable outcome. A comprehensive review of the literature pertaining to this condition is presented outlining the pathophysiology, pattern of presentation and the treatment strategies necessary for successful management of this massive infectious soft tissue disease