TY - CHAP M1 - Book, Section TI - Necrotizing Fasciitis A1 - Ritter, Kathryn A1 - Fitch, Robert Warne A2 - Knoop, Kevin J. A2 - Stack, Lawrence B. A2 - Storrow, Alan B. A2 - Thurman, R. Jason Y1 - 2021 N1 - T2 - The Atlas of Emergency Medicine, 5e AB - This uncommon, severe infection involves the subcutaneous soft tissues, including the superficial and deep fascial layers. It is usually seen in the lower extremities, abdominal wall, and perianal or groin area. It is commonly spread from a trauma site, surgical wound, abscess, or decubitus ulcer. Alcoholism, parenteral drug abuse, and diabetes are predisposing factors. Pain, tenderness, erythema, swelling, warmth, shiny skin, lymphangitis, and lymphadenitis are early findings. Later, there is rapid progression of bullae with clear pink or purple fluid and cutaneous necrosis; the skin becomes anesthetic, and subcutaneous gas may be present. Systemic toxicity may be manifest by fever, dehydration, leukocytosis, and frequently positive blood cultures. Type I is polymicrobial and includes anaerobic species. Type II includes group A streptococci. SN - PB - McGraw-Hill CY - New York, NY Y2 - 2024/03/28 UR - accessmedicine.mhmedical.com/content.aspx?aid=1181043513 ER -