Skin and soft tissue infectionsThe diagnosis of necrotizing fasciitisWong, Chin-Hoa; Wang, Yi-ShibAuthor Information aDepartment of Plastic Surgery, Singapore General Hospital bDivision of Dermatology, Department of Internal Medicine, Changi General Hospital, Singapore Correspondence to Dr Chin-Ho Wong, Department of Plastic Surgery, Singapore General Hospital, Outram Road, Singapore 169608 Tel: +65 6321 4686; fax: +65 6220 9340; e-mail: [email protected] Current Opinion in Infectious Diseases: April 2005 - Volume 18 - Issue 2 - p 101-106 doi: 10.1097/01.qco.0000160896.74492.ea Buy Metrics Abstract Purpose of review A delay in the diagnosis and appropriate treatment of necrotizing fasciitis has clearly been demonstrated to increase mortality. However, paucity of specific cutaneous signs makes early recognition extremely difficult. This review highlights recent developments in the approaches to the diagnosis of necrotizing fasciitis. Recent findings A clinical staging of necrotizing fasciitis is proposed to better define the progression of the disease. Several clinical subtypes of necrotizing fasciitis have been described recently with hyperacute and sub-acute variants. Imaging techniques, such as magnetic resonance imaging and frozen section biopsies, have been reported to be of value in the early recognition of necrotizing fasciitis. However availability and cost limit the routine use of these tests. Several diagnostic adjuncts that have been developed recently to help in early recognition will be discussed. These include the fasciitis LRINEC (laboratory risk indicator for necrotizing fasciitis) score and transcutaneous tissue oxygen saturation monitoring. Some may have the potential for widespread application in the assessment of severe soft tissue infections. Summary Delayed recognition, with consequent massive soft tissue loss and sepsis, remains a deadly pitfall in the management of necrotizing fasciitis. With a better understanding of the clinical manifestations and the potential use and limitations of various diagnostic adjuncts available for the assessment of equivocal cases of soft tissue infections, it is hoped that a clear and logical approach to the diagnosis of necrotizing fasciitis may be developed. © 2005 Lippincott Williams & Wilkins, Inc.