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Staging of necrotizing fasciitis based on the evolving cutaneous features

Authors

  • Yi-Shi Wang MBBS, MRCP,

    1. From the Division of Dermatology, Changi General Hospital, Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
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  • Chin-Ho Wong MBBS, MRCS,

    1. From the Division of Dermatology, Changi General Hospital, Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
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  • Yong-Kwang Tay MBBS, FRCP

    1. From the Division of Dermatology, Changi General Hospital, Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
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  • Presented at the European Academy of Dermatology and Venereology (EADV) 14th Congress, London, October 12 to 16, 2005.

Yi-Shi Wang, MBBS, MRCP Division of Dermatology Changi General Hospital2 Simei Street 3 Singapore 529889E-mail: yishiw@hotmail.com

Abstract

Background  Necrotizing fasciitis is a severe soft-tissue infection characterized by a fulminant course and high mortality. Early recognition is difficult as the disease is often clinically indistinguishable from cellulitis and other soft-tissue infections early in its evolution. Our aim was to study the manifestations of the cutaneous signs of necrotizing fasciitis as the disease evolves.

Methods  This was a retrospective study on patients with necrotizing fasciitis at a single institution. Their charts were reviewed to document the daily cutaneous changes from the time of presentation (day 0) through to day 4 from presentation.

Results  Twenty-two patients were identified. At initial assessment (day 0), almost all patients presented with erythema, tenderness, warm skin, and swelling. Blistering occurred in 41% of patients at presentation whereas late signs such as skin crepitus, necrosis, and anesthesia were infrequently seen (0–5%). As time elapsed, more patients had blistering (77% had blisters at day 4) and eventually the late signs of necrotizing fasciitis characterized by skin crepitus, necrosis, and anesthesia (9–36%) were seen. A clinical staging system was developed based on our observations. Stage migration from early to late stage necrotizing fasciitis was evident with majority of patients in stage 1 at day 0 (59%), whereas by day 4, majority had developed into stage 3 (68%).

Conclusion  This study has demonstrated the continuum of cutaneous manifestations as necrotizing fasciitis evolves. This will help in the early recognition and intervention of this devastating condition.

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