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Necrotising Fasciitis
Necrotising Fasciitis Debridement

Necrotising Fasciitis Debridement

The main treatment for necrotising fasciitis is debridement surgery. Without this treatment, the patient's life will be at risk.

Necrotising fasciitis

Necrotising fasciitis is a bacterial infection. It affects the body's deep tissues, including the subcutaneous tissue, fascia and muscle. It causes the tissue to die, which in medical terms is called tissue necrosis.

Necrosis happens because the bacteria enter the body and travel to the deep tissues. The bacteria then begin to reproduce, a process which releases a toxin into the body. This damages the nearby tissue, harming the blood vessels and disrupting the blood supply.

Without blood the tissue will become 'ischaemic', which means it is deficient in oxygen (because blood carries oxygen to the tissues). The cells will soon die and the tissue will become necrotic, where it is clinically dead. Necrotic tissue cannot be revived.

Necrotising fasciitis treatment

The only way to successfully treat necrotising fasciitis is with debridement surgery. Debridement surgery is when all dead and infected tissue is surgically cut away.

It is important that all the infected tissue is removed, or treatment will not be effective. Surgery must therefore be extensive to ensure no infective tissue remains. More than one procedure may be required to bring the infection under control. Sometimes a patient will need several debridement procedures on consecutive days.

The amount of tissue that is ultimately removed will directly correlate to the amount of tissue that has become infected. The bacteria reproduce and spread very quickly. So if surgery is carried out shortly after the infection begins, the patient may be fortunate enough to only need minimal debridement.

But if there is a delay in treatment, the bacteria may have spread way beyond the original site of infection. If so, a large amount of tissue will have to be cut away. There are cases of so much tissue being cut away the bone is exposed. Sometimes an internal organ, such as the bowel, will be infected and will need to be re-sected. Sometimes the infection will get into the bone and a limb amputation will be required.

Other treatment

In addition to surgical debridement, the patient will require additional treatment in the form of intravenous antibiotics and intravenous fluids. The antibiotics will initially be broad-spectrum as it will not be known what organism is causing the illness. But the medication can be refined once the laboratory results specify exactly which bacteria are present.

The patient will usually need to be admitted to the Intensive Care Unit, particularly if their organs have been to shut down and need to be supported. This is a very real risk of necrotising fasciitis. Because of the speed at which the bacteria can spread, they can easily reach the bloodstream. This can trigger a reason known as 'sepsis', which in turn leads to organ dysfunction.

Furthermore, having a large amount of tissue removed can have serious health implications as the body can go into shock.

Treatment following debridement surgery

Once all the necrotic tissue has been surgically removed, the patient will need ongoing treatment. As mentioned above, this will initially be in the Intensive Care Unit or Critical Care Unit. The surgical wound must be closely monitored because it will be vulnerable to further infection. This can be prevented with intravenous antibiotics and good hygiene of the wound. The dressings should be changed daily. This can be excruciatingly painful and the patient may have to be sedated. He/she will also require pain relief throughout the day.

If the surgical wound is very large, the patient may have to undergo vacuum assisted closure. The plastic reconstruction team may also be asked to help the wound closure with skin grafts. Further reconstructive surgery may be necessary to improve the aesthetic appearance of the wound, the sight of which can be very distressing to patients. Indeed, the scarring can cause all sorts of body confidence issues, and can also bring back bad memories that leave the patient anxious and upset.

In the shorter term, the dressings will still need to be changed regularly. It can take a very long time for the wound to fully close, and until then dressings will be needed. The patient may be discharged from hospital but will still have to attend their GP surgery (or be visited by the district nurse) to have the dressings changed.

Timing of debridement surgery

Note must also be given to the timing of debridement surgery. This is very important because debridement surgery must be performed as early as possible. This will prevent the spread of bacteria, limiting the impact of the infection and minimising the amount of tissue debridement. Even a delay of just a few hours can have devastating implications. In fact, it may be the difference between the patient surviving necrotising fasciitis and the patient suffering fatal complications.

Unfortunately necrotising fasciitis does have high mortality rates because the initial symptoms mimic less serious illnesses, such as the flu. The patient therefore delays seeking medical attention in the early stages, and only reaches a medical setting once their condition is critical.

However, there are also times when the same mistake is made by medical practitioners. The patient attends their GP or hospital, but their symptoms are attributed to a more minor condition. By the time a correct diagnosis is made, the patient has experienced widespread necrosis and a degree of organ dysfunction. A large amount of tissue will then have to be debrided. Sadly the patient may not survive.

Medical errors are to blame

If medical errors are to blame for a delay in debridement surgery, causing a patient to suffer extensive tissue death and further complications, there could be a case of medical negligence. This is because medical practitioners should be able to diagnose necrotising fasciitis promptly, and should also be aware of the need for emergency surgery. A failure to provide this standard of care could amount to negligence.

For more information on necrotising fasciitis claims, please get in touch with us at Glynns Solicitors.

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