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J Am Acad Orthop Surg, Vol 17, No 3, March 2009, 174-182.
© 2009 the American Academy of Orthopaedic Surgeons
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Necrotizing Fasciitis

Joseph M. Bellapianta, MD, Karin Ljungquist, MD, Ellis Tobin, MD and Richard Uhl, MD

Dr. Bellapianta is Chief Orthopaedic Resident, Albany Medical Center, Albany, NY. Dr. Ljungquist is Orthopaedic Resident, Ohio State University Medical Center, Columbus, OH. Dr. Tobin is Clinical Associate Professor, Department of Medicine, Albany Medical College, Albany, NY. Dr. Uhl is Professor of Surgery, Division of Orthopaedic Surgery, Albany Medical College.

Dr. Uhl or a member of his immediate family is a member of a speakers’ bureau or has made paid presentations on behalf of AO and has received research or institutional support from CONMED Linvatec, DePuy, Smith & Nephew, Stryker, and Synthes. None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Bellapianta, Dr. Ljungquist, and Dr. Tobin.

Reprint requests: Dr. Bellapianta, Albany Medical College, Suite 202, 1367 Washington Avenue, Albany, NY 12206.

Necrotizing fasciitis is a rare but life-threatening soft-tissue infection characterized by rapidly spreading inflammation and subsequent necrosis of the fascial planes and surrounding tissue. Infection typically follows trauma, although the inciting insult may be as minor as a scrape or an insect bite. Often caused by toxin-producing, virulent bacteria such as group A streptococcus and associated with severe systemic toxicity, necrotizing fasciitis is rapidly fatal unless diagnosed promptly and treated aggressively. Necrotizing fasciitis is often initially misdiagnosed as a more benign soft-tissue infection. The single most important variable influencing mortality is time to surgical débridement. Thus, a high degree of clinical suspicion is necessary to avert potentially disastrous consequences. Orthopaedic surgeons are often the first to evaluate patients with necrotizing fasciitis and as such must be aware of the presentation and management of this disease. Timely diagnosis, broad-spectrum antibiotic therapy, and aggressive surgical débridement of affected tissue are keys to the treatment of this serious, often life-threatening infection.






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Copyright © 2009 by the American Academy of Orthopaedic Surgeons.