Necrotising fasciitis is an infection of the subcutaneous tissue. It can be difficult to diagnose, meaning patients who develop the infection often suffer a delay in treatment.
Why is necrotising fasciitis so difficult to diagnose?
Severe infections of the subcutaneous tissues and skeletal muscle are not only rare but also notoriously difficult to diagnose. The classification of these conditions is controversial, and confusion is common among medical practitioners.
Necrotising fasciitis is an unusual and severe soft tissue infection in which bacterial toxins are responsible for the breakdown of subcutaneous fat. The onset of necrotising fasciitis is deceptive. The patient may complain only of pain at the site of infection, and often this does not have any obvious cause.
Physical signs – such as the discoloration of the skin (skin gangrene) – are late manifestations of the condition, only occurring when the skin is deprived of its blood supply. Signs of severe sepsis will develop even later, with rapid deterioration as the condition moves from a localised infection of the tissue to a bloodstream infection with severe septicaemia and toxaemia.
Therefore necrotising fasciitis is difficult to diagnose because the early symptoms are vague. A patient may even appear systemically well in the early stages. Only when the condition reaches the later stages is it apparent that a severe infection is present.
Complications of a delay in treatment
However, by the time physical signs of necrotising fasciitis have developed, it may be too late for a patient.
Indeed, by the time the infection reaches the bloodstream, the mortality rates stands at 30 to 50%. Without adequate antibiotics and urgent surgical debridement of the skin, subcutaneous tissue and affected muscle, the mortality rates approaches 100%.
Because of the urgency with which treatment must be provided, it is vital medical practitioners understand the progression of necrotising fasciitis. This can be described in three stages:
- Stage one – tenderness of the tissue, red skin that is hot to touch, swelling
- Stage two – blister formation
- Stage three – crepitus (crackling sounds/sensation under the skin), skin anaesthesia and skin necrosis will a dusky discoloration
Medical professionals should recognise these symptoms as being indicative of infection and manage a patient accordingly. Antibiotics should be started at the earliest opportunity and urgent microbiological investigations carried out. This will ensure that a timely diagnosis is obtained, before it is too late.
Failure to diagnose and treat necrotising fasciitis
If doctors fail to diagnose and treat necrotising fasciitis, there may be a case of medical negligence. Contact us today to find out more.
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