This is a bacterial infection that often requires special attention since it is associated with extreme morbidity. It is a mixed bacterial infection whose pathogenesis principally involves extensive and rapid destruction of fascia, almost exclusively around the neck and craniofacial area. The exact pathophysiology of the exclusive fascial damage remains unknown, however, Paradoxically, no specific mirco-organisms have been implicated in the pathology of this condition. Once fascia is destroyed, the coring skin remains without nutrients and support, thereby breaking down to expose the underlying structures. Since this condition may not be as uncommon as medical literature may imply, clinicians are prompted to recognize it. The hallmark of the condition is that it may present with little suppuration and yet there will be extensive fascial necrosis with consequent skin breakdown.
Management
- Admit the patient for rehydration.
- Initiate antibiotics: Amoxicillin+Clavulanic acid 1.2g IV 12 hourly+metronidazole 500mg IV 8 hourly+gentamicin 80mg IV 8 hourly and intramuscular diclofenac 75mg IM 12 hourly.
- \Smab for culture and sensitivity.
- Conduct surgical consultation for appropriate intervention: Mop out necrotic tissue meticulously with copious antiseptic irrigation(hydrogen peroxide/povidone iodine).
- Dress exposed tissues appropriately and allow for adequate healing before plastic surgery intervention.