Necrotising Fasciitis

Introduction The term necrotising fasciitis (NF) was first coined in 1952 by Wilson1 to describe a rapidly progressive inflammation and necrosis of subcutaneous tissues and the deep layer of superficial fascia with sparing of the deep fascia and muscle. It had previously been described variously as haemolytic gangrene, acute streptococcal gangrene, gangrenous erysipelas, necrotising erysipelas, suppurative fasciitis, and hospital gangrene, among other names.2,3 However, the term necrotising fasciitis is now used in a generic sense to include all diffuse necrotising soft tissue infections except gas gangrene (clostridial myonecrosis).4 Diffuse necrotising soft tissue infections include classic gas gangrene, Meleney’s haemolytic streptococcal gangrene, necrotising fasciitis as described by Wilson, and the gram-negative synergistic necrotising cellulitis of Stone. Generally, one condition cannot be distinguished from another at the time of diagnosis. Today, the orofacial form of NF is called cancrum oris (noma),5 and the perineal form is called Fournier’s gangrene. Idiopathic scrotal gangrene, however, is different in aetiology, extent, and clinical presentation from Fournier’s gangrene.4 NF poses a serious surgical challenge not only because of its rapid and progressive nature, but also because of its attending high morbidity and mortality.6,7