[Necrotizing fasciitis of the upper limb: a case]

Necrotizing fasciitis is a rare form of anaerobic infection, quite different from gas forming gangrene: it affects the skin, the cellular tissue, the fascia; it doesn't diffuse in depth to the muscles and doesn't produce gas. Its microbic agents vary from haemolytic streptococcus to anaerobic bacteria in synergy. It rapidly spreads into a massive necrosis and can in a week's time lead to death by toxic shock. It spreads locally to large cutaneous areas eventually leading to the necessity of amputations. A joint treatment must be started with extreme urgency: extensive surgical excisions of all necrotic teguments, and medical treatment consisting of correcting metabolic troubles and antibiotherapy. This difficult treatment can save the patient, but it involves great loss of cutaneous and subcutaneous substance leading to local problems which are similar to serious burns, then to problems of reconstruction. An open fracture of the elbow led to an observation. A review of the literature sets out the different forms and complications.