Presentation
A chronically debilitated, uncontrolled diabetic patient underwent right lower limb amputation followed by chemotherapy with a long history of bedridden and generalized infection.
Patient Data
There are changes related to the right whole lower limb amputation involving the hip joint with operative bed small localized collection filling the acetabular fossa.
There are extensive diffuse interstitial edematous changes involving subcutaneous and deep soft tissue structures extending to pelvic floor musculature as well as glutei muscles with the small right intermuscular localized collection; upper thigh muscles are involved as well.
Marked diffuse scrotal interstitial edema is noted with mild bilateral scrotal hydrocele.
Mild to moderate pelvic peritoneal collection.
Case Discussion
Necrotizing fasciitis is a rapidly progressive inflammatory process of the fascia, with secondary involvement of the subcutaneous tissues.
Necrotizing fasciitis tracks along the different fascial planes. The causative bacteria may be aerobic, anaerobic, or, as is now recognized, typically a mixed flora of micro-organisms. Organisms spread from the subcutaneous tissue through the superficial and deep fascial planes, facilitated by bacterial enzymes and toxins.
The deeper infection and extension carry increased morbidity and mortality due to vascular occlusion, ischemia, and tissue necrosis.
The incidence of necrotizing fasciitis is increasing due to the higher number of immuno-compromised patients under medical care as well as the wide use of antibiotics with bacterial resistance.
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