Necrotizing soft tissue infections are a category of bacterial infection characterized by rapidly progressive tissue destruction involving the skin, subcutaneous fat, deep fascia, and/or muscle.
Traditionally, such infections have been separated by the depth of involvement 1,2:
- necrotizing fasciitis, the most well known
- necrotizing myositis, including clostridial myonecrosis (gas gangrene)
- necrotizing cellulitis/adipositis
For several reasons, however, the overarching term of "necrotizing soft tissue infection" has been promoted. Involvement of adjacent levels can occur and, adding to the confusion, different authors and practitioners disagree on the definition of fascia 2,3. Moreover, the pathophysiology and clinical manifestations overlap. Most importantly, the management strategy for different necrotizing soft tissue infections is similar 1,4-6.
- Fournier gangrene: necrotizing soft tissue infection of perineum
- 1. Goldstein EJC, Anaya DA, Dellinger EP. Necrotizing soft-tissue infection: diagnosis and management. (2007) Clinical Infectious Diseases. 44 (5): 705-10. doi:10.1086/511638 - Pubmed
- 2. Hayeri MR, Ziai P, Shehata ML, Teytelboym OM, Huang BK. Soft-Tissue Infections and Their Imaging Mimics: From Cellulitis to Necrotizing Fasciitis. (2016) Radiographics. 36 (6): 1888-1910. doi:10.1148/rg.2016160068 - Pubmed
- 3. Lee S, Joo KB, Song SY. Accurate definition of superficial and deep fascia. (2011) Radiology. 261 (3): 994; author reply 994-5. doi:10.1148/radiol.11111116 - Pubmed
- 4. Sarani B, Strong M, Pascual J, Schwab CW. Necrotizing fasciitis: current concepts and review of the literature. (2009) Journal of the American College of Surgeons. 208 (2): 279-88. doi:10.1016/j.jamcollsurg.2008.10.032 - Pubmed
- 5. Dellinger EP. Severe necrotizing soft-tissue infections. Multiple disease entities requiring a common approach. (1981) Journal of the American Medical Association. 246 (15): 1717-21. Pubmed
- 6. Stevens DL, Bryant AE. Necrotizing Soft-Tissue Infections. (2017) New England Journal of Medicine. 377 (23): 2253-2265. doi:10.1056/NEJMra1600673 - Pubmed