Fasciotomy and Debridement in Alpha-Hemolytic Associated Type II Necrotizing Fasciitis of The Hand: A Case Report

Necrotizing Fasciitis (NF) is a rare and potentially life-threatening infection affecting the skin and soft tissue. Its incidence is estimated at 4 cases per 100,000 people a year in the United States. Gram-positive cocci are the common causative organism. With a mortality rate of 25% to 35%, it should be diagnosed as soon as possible, and the treatment should be expedited. A 68-year-old woman presented with acute disturbed consciousness, accompanied by fever, swelling, and pain on the index finger of the right hand. She gave a history of a cut finger one day prior. Her index finger appeared pale and cold in touch with no capillary refill time and was insensate. Initially, she was diagnosed with a diabetic hand. With the disease progressivity combined with laboratory and ultrasonography results, she was diagnosed with NF, and emergency debridement and fasciotomy were done. NF is a lethal and fast progressing Skin and Soft Tissue Infections (SSTIs) that should be diagnosed early to reduce the mortality rate. A slower rate of infection does not exclude NF as a diagnosis because many factors can affect it, such as its aetiology, coexisting disease, or our empiric antibiotic. In treating NF, a blood culture should be done to identify its cause, and we should perform adequate surgical debridement with or without fasciotomy based on its manifestations.