Gynecology

Question:

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The rapid onset of the patients symptoms along with her hypotension, fever, purulent discharge and crepitus on examination indicate necrotizing fasciitis. Necrotizing fasciitis is a rare infection of the superficial fascia and subcutaneous tissue. It is usually seen in patients compromised by diabetes mellitus, radiation therapy, or obesity. However, necrotizing fasciitis can arise in the vulva following episiotomy, bartholin duct abscesses and denovo. (73)

The syndrome is characterized by infection of the superficial fascia including Colles, Scarpa and Campers fascia. The infection is generally polymicrobial and can include any of a number of gram-negative aerobic bacilli, Bacteroides species or streptococci.

When the diagnosis of necrotizing fasciitis is suspected it should be confirmed by surgical intervention and aggressive debridement. Involved tissues are typically greyish and boggy with little tendency to bleed. This tissue should be completely resected until healthy, well-vascularized tissue is encountered. The wound should not be closed primarily and the patient should be given broad-spectrum antibiotics. (73)

Hyperbaric oxygen therapy may be of some benefit in conjunction with surgical debridement, particularly in patients for whom culture results are positive for anaerobic organisms.

References:

73. Cruikshank SH ML: A de novo case of vulvar synergistic necrotizing fasciitis. Obstet Gynecol 1987; 69: 516-520.

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