Multifocal necrotising fasciitis: an overlooked entity?

Area of Science:

• Infectious Diseases
• Surgical Pathology
• Medical Research Methodology

Background:

• Necrotising fasciitis is a severe, life-threatening soft tissue infection.
• Multi-focal necrotising fasciitis (multiple non-contiguous necrotic areas) is rarely reported.
• Lack of specific guidelines and under-reporting hinder effective management.

Purpose of the Study:

• Report a case of multi-focal necrotising fasciitis.
• Review literature to identify etiological factors.
• Suggest improvements for managing multi-focal necrotising fasciitis.

Main Methods:

• Systematic literature review following PRISMA protocol.
• Searched MEDLINE, OLD MEDLINE, and Cochrane Collaboration (1966-2011).
• Extracted data on demographics, injury, timeline, microbes, sites, scores, treatment, and outcomes for 33 cases.

Main Results:

• 31 studies and 33 cases of multi-focal necrotising fasciitis analyzed.
• 52% of cases were type II necrotising fasciitis.
• Identifiable inciting injuries in 42%; 21% developed non-synchronous lesions (86% type II).
• Objective assessment scores were incomplete in 94% of cases.

Conclusions:

• Multifocality in necrotising fasciitis is linked to type II disease.
• Validated objective tools may aid in identifying high-risk patients for early imaging.
• Recommends adopting regional multi-focal necrotising fasciitis registers for improved management.