[Necrotizing fasciitis of the upper and lower extremities]

Necrotizing fasciitis is a potentially fatal soft tissue infection that may affect the upper and lower extremities, scrotum, perineum and abdominal wall. Typically, the infection demonstrates rapid spreading along the fascial planes leading to sepsis with mortality rates of 15-46%. Without adequate treatment, the mortality rate increases to close to 100%. There are four groups of pathogens that can lead to necrotizing fasciitis, namely beta-hemolytic group A streptococci, mixed infections with obligate and facultative anaerobes, clostridium species and fungal infections. Clinical signs may include erythema, edema and pain out of proportion in the early stages and soft tissue necrosis with bullae during the subsequent course. In some cases, only a deterioration of the general condition is evident and the aforementioned clinical symptoms are initially missing. The decision for treatment is based on the clinical diagnosis and surgical debridement is the cornerstone of treatment, accompanied by broad spectrum i.v. antibiotic treatment, e. g. with penicillin, ciprofloxacin and clindamycin.