Definition

Synonym: Necrotizing, necrotic érésipèle, dermal gangrene, gangrene hospital acute, fulminant cellulitis. Infection hypodermal fascia (fascia situated under the DermIS) secondary to a variety of bacteria: anaerobic streptococci. NF causes necrosis (tissue destruction) accompanied by edema which is very fast, which leads to bleeding and bubbles (large vesicles containing liquid) as well as a State of shock, during which the bodies are more able to ensure their main function. Fasciitis is inflammation of a fascia or fasciae (fabric that envelopes the muscles and organs) by definition due to infection itself due to the penetration of germs in these tissues. Necrotizing Fasciitis (which destroyed tissue) was once called gangrene of streptococcal origin (a group A streptococcal infection). It can also return in a gas gangrene after the penetration of a germ, the Clostridium perfringens. The origins of Necrotizing Fasciitis are multiple. This can be (the list is not exhaustive): banal wound A slightly deeper than usual A hemorrhoid scratch A diverticulum (contacting a hollow organ, essentially the gut cavity) an anal fissure rupture of the urethra (led urinary carrying urine from the bladder to the outside) certain diseases facilitate the occurrence of NF as diabetes disease affecting vessels (angiopathy) surgical injury following the penetration of an object in the abdomen it is a special case of Necrotizing called Fournier gangrene characterized by significant swelling of the scrotum (skin envelope of the testes). Diagnosis Is sometimes difficult. Initially, the patient complains of: pain fever unexplained swelling hard Œdème and slightly painful red stain dark and elevation of the skin Evolution quick, there is the constitution of bubbles filled with a blue liquid on the violet. Later, the skin becomes fragile and has a color pulling on the blue, and brown or black. Secondly, the infection is likely to achieve deep fascia (fibrous membranes which envelop the muscles by separating from each other). She eventually give a grey colour dark skin of the affected part. At this advanced stage, patients experience shock and toxic signs that reflect a lack of function of several organs. Shock, also known as sepsis, is widespread throughout the body inflammation, and translates into a failure of all internal organs which ensure more their role normally. Gas gangrene, which is the stage in the evolution of Necrotizing Fasciitis, translates a (dead) tissue necrosis, due most often to a lesion of the skin or mucous membranes following a surgical accident. It is also favoured by the occurrence of the hematoma or penetration of a foreign body through the wound (Earth more often). The multiplication of germs results in a foul-smelling gas which broadcasts under the skin and is on palpation the so-called gas crepitus (evokes the sound a person walking in the snow). Gas gangrene in the patient leads to a weaker with a significant fall of blood pressure and other local signs and quickly scalable generals. The pain is intense, the high fever. Fortunately, this disease is currently almost more observed. Nevertheless, it still affects diabetics who are particularly sensitive to any form of infection. Necrotizing Fasciitis treatment includes: cleaning of the wound A debridement of skin fascia and muscle (large incision in the infected area) A levy and a culture of germs implementation are made at the same time. Administration of associations of antibiotics intravenously (Doxycycline, Cefazolin and tobramycin) gas gangrene requires treatment by oxygen (hyperbaric oxygen administration: high pressure) and the removal of necrotic tissue (dead). The prognosis is nevertheless very reserved. Another form of Necrotizing Fasciitis there is a form of Necrotizing Fasciitis secondary to a microbe called Pyogenic Staphylococcus and whose frequency increased in severity since the 1980s. Outbreaks of these germs always results in a manufacture of gas led to kidney failure (renal function failure) in approximately 30% of cases. Myositis (inflammation of the muscle), pain and progressive destruction of muscles, occurs in most cases. Creatine phosphokinase (enzyme of muscular origin) is usually increased. A quick surgical excision addressing the deep fascia and muscles is a friendly gesture, which must be accompanied by a removal of dead tissue.