Differential diagnosis. The diagnosis is clinical - if there is strong clinical suspicion of NF, exploratory surgery is required regardless of test results

Diagnosis

The diagnosis is clinical - if there is strong clinical suspicion of NF, exploratory surgery is required regardless of test results. During surgery, the diagnosis of NF is made on its macroscopic features, which include: grey necrotic tissue, lack of bleeding, thrombosed vessels, "dishwater pus", lack of resistance to finger dissection and non-contracting muscle

Be aware that:

Necrotising fasciitis is difficult to diagnose in its initial stages, as it mimics cellulitis.

Important early clues are pain, tenderness and systemic illness out of proportion to the localised physical signs.

Bullae and ecchymotic skin lesions also point to the condition (and are not normally found with cellulitis).

A high index of suspicion is necessary and suspected cases should be referred immediately. Prompt surgical debridement is essential.

· Cellulitis or erysipelas.

· Pyoderma gangrenosum.

· Limb ischaemia, compartment syndrome.

· Deep vein thrombosis or thrombophlebitis.

· Osteomyelitis with soft tissue involvement.

Image 7.6 Necrotizing fasciitis of the periumbilical area. Group B streptococcus, Staphylococcus aureus, and anaerobic streptococci were isolated at the time of surgical debridement.

Image 7.7 Necrotizing fasciitis of the external ear. The pinna at the left side is edematous and erythematous, with necrosis of the tragus and preauricular oedema.

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