Algorithm for early diagnosis of necrotizing soft tissue infection

Alisher Okhunov; Dilshod Korikhonov

Necrotizing fasciitis is a well-recognized severe, rapidly or rapidly progressing disease of soft tissue infections accompanied by severe intoxication, predominantly affecting the fascia, muscles or adipose tissue, proceeding without the formation of purulent exudate or with a disproportionately small amount of it. 

These diseases and complications are found in the practice of any surgeon, regardless of specialization.

The clinical picture and features of the course of necrotizing fasciitis in 45 patients who were treated and examined in the multidisciplinary clinic of the Tashkent Medical Academy from 2020 to 2022 were analyzed. 

As the first symptom, all patients reported moderate pain in the affected part of the body without well-defined boundaries. The nature of the pain of 41 (91.1%) patients was described as aching. In other cases, patients noted pulling or pressing, bursting pain. In 33 (73.3%) follow-ups, patients could not localize pain, characterizing it as diffuse. 

Of the specific signs of necrotizing fasciitis in our patients, a variety of skin discolouration most often occurred. Characteristic bluish or brownish spots were noted in 37 (82.2%) cases. Uniform skin cyanosis with areas of black or dark purple necrosis was present in 15 (33.3%) patients. Epidermal detachment in the form of bluish-grey bullae filled with dark cloudy fluid was observed in 26 (57.8%) patients. In 3 (6.7%) people, skin infiltration in the form of "lemon peel" was detected. As a rule, fluctuations in necrotizing fasciitis were not detected in our observations. Crepitus on palpation was present in 13 (28.9%) cases.

In 13 (28.9%) patients, the body temperature remained normal, 15 (33.3%) had a low-grade fever, 5 (11.18%) had a fever above 39.2 °C, and in the remaining 9 (20.0%) patients, the body temperature was in the range of 38.0-39.1 °C. Hypothermia was observed in 2 (4.48%) patients. In 3 (6.7%) patients, fever was noted during the first hours, and in 6 (13.3%) - in the first day after the onset of the disease.

In the early stages of the disease, the diagnosis of necrotizing soft tissue infection can almost always be established based on an assessment of the clinical picture of the disease.  Diagnostic puncture is not an informative method for diagnosing necrotizing infections. The differential diagnosis of soft tissue necrotizing infection should be made with a range of infectious and non-infectious lesions. If necrotizing infection is suspected, surgical revision of all soft tissue layers is indicated.