[Necrotizing fasciitis. A diagnostic and therapeutic challenge]

A case of necrotizing fasciitis of the upper limb caused by group A streptococcal infection and a case with an abscess of the hand caused by staphylococcus aureus, are presented. The anatomo-pathological and clinical differences between the two different types of infection are underlined and stress is laid on the excruciating pain, the high temperature and the rapidly spreading inflammatory-necrotizing evolution of the first case. More than the anatomo-pathological findings of a necrotic area the authors consider more important, the rapidity and the severity of the infection, that can evolve into a toxic shock-like syndrome, and the microbiological isolation of the streptococcus type A. On the basis of personal experience and of an accurate review of the literature, a therapeutical protocol is proposed based on an aggressive surgical approach, prompt specific antibiotic treatment and daily control of the lesions.