Necrotizing fasciitis physical examination
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Physical examination of patients with necrotizing fasciitis is usually remarkable for local soft tissue signs such as warmth, tenderness beyond margins of erythema, swelling, erythema with ill defined margins, blistering/bullae, skin discoloration, foul discharge (greyish or brown discharge), fluctuance, crepitus, skin sloughing or necrosis, absence of lymphangitis or lymphadenopathy (lymphangitis is rarely observed in necrotizing fasciitis patients), sensory and motor deficits (e.g. localized anesthesia). Finger probe test is useful in the diagnosis of necrotizing fasciitis.
Appearance of the patient
- Patients with necrotizing fasciitis appear fatigued during early stages and may have altered mental status during late stages. In end stage necrotizing fasciitis, patients exhibit signs of septic shock.
- Tenderness beyond margins of erythema
- Erythema with ill defined margins
- Skin discoloration
- Foul discharge (greyish or brown discharge)
- Skin sloughing or necrosis
- Absence of lymphangitis or lymphadenopathy (lymphangitis is rarely observed in necrotizing fasciitis)
- Sensory and motor deficits (e.g. localized anesthesia)
|Early||● Tenderness to palpation (extending beyond the apparent area of skin involvement) |
● Warm to palpation
|Intermediate||● Blister or bullae formation (serous fluid) |
● Skin fluctuance
● Skin induration
|Late||● Hemorrhagic bullae |
● Skin anesthesia
● Skin necrosis with dusky discoloration progressing to frank gangrene
Finger Probe Test
- Finger probe test is useful in the diagnosis of necrotizing fasciitis.
- This test is carried out in the ward, emergency room and in the theatre under local or general anesthesia.
- After infiltrating the area, a 2cm incision is made down to the deep fascia.
- Fascia will be swollen and grey on gross inspection.
- Gentle probing with index finger is performed at the level of deep fascia and if the tissue dissects with the minimal resistance, then finger probe test is considered positive.
- Signs suggesting necrotizing fasciitis include:
- Lack of bleeding
- Lack of normal tissue resistance on finger probe
- Oozing of malodorous "dish water fluid"
- Young MH, Aronoff DM, Engleberg NC (2005). "Necrotizing fasciitis: pathogenesis and treatment". Expert Rev Anti Infect Ther. 3 (2): 279–94. doi:10.1586/1478718.104.22.1689. PMID 15918785.
- Puvanendran R, Huey JC, Pasupathy S (2009). "Necrotizing fasciitis". Can Fam Physician. 55 (10): 981–7. PMC 2762295. PMID 19826154.