This is a dangerous and rapidly spreading infection of
the fascial planes leading to necrosis of the subcutaneous tissues and
overlying skin . It is caused by beta haemolytic streptococci and occasionally
staphylococcus aureus but may take the form of a polymicrobial infection
associated with other aerobic and anaerobic pathogens including Bacteroids
,Clostridia , Proteus , Pseudomonus and Klebsiella . It is termed Fouerniers
gangrene when it affects the perineal area and Meleney,s synergistic gangrene
when it involves the abdominal wall . It includes acute inflamatory infiltrate
, extensive necrosis , oedema and thrombosis of the microvasculature . The area
becomes oedematous , painful and very tender . The skin turns blue and black
secondary to the progressive underlying thrombosis and necrosis .
The
area may develop bullae and progress to overt cutaneous gangrene with
subcutaneous emphysema . It is accompanied by fever and severe generalised
toxicity . Renal failure as a result of hypovolaemia and cardiovascular
collapse caused by septic shock may occur . Unless aggressively treated it
leads to serious consequences with a mortality rate approximately 70% .
The
diagnosis is made on clinical grounds . Creatinine kinase level may show
enermous elevation and biopsy of the fascial layers can confirm the diagnosis
.Patients are admitted to ICU .
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