Necrotizing fasciitis physical examination

Necrotizing fasciitis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Necrotizing fasciitis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X Ray
CT
MRI
Ultrasound
Biopsy
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Future or Investigational Therapies
Case Studies
Case #1
Necrotizing fasciitis physical examination On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Necrotizing fasciitis physical examination All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Necrotizing fasciitis physical examination
CDC on Necrotizing fasciitis physical examination
Necrotizing fasciitis physical examination in the news
Blogs on Necrotizing fasciitis physical examination
Directions to Hospitals Treating Necrotizing fasciitis
Risk calculators and risk factors for Necrotizing fasciitis physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]

Overview

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.

Physical Examination

Common physical examination findings associated with necrotizing fasciitis may include:

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.

Vital signs

• Fever (may be absent)
• Tachycardia
• Low blood pressure
• Tachypnea

Skin

• Jaundice
• Evidence of trauma, surgery, insect or human bites, or injection sites

Local examination

• Induration
• 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)
• Sensory and motor deficits (e.g. localized anesthesia)

Stage (Early)	Signs
Early	● Tenderness to palpation (extending beyond the apparent area of skin involvement) ● Erythema ● Swelling ● Warm to palpation
Intermediate	● Blister or bullae formation (serous fluid) ● Skin fluctuance ● Skin induration
Late	● Hemorrhagic bullae ● Skin anesthesia ● Crepitus ● Skin necrosis with dusky discoloration progressing to frank gangrene

Finger Probe Test

• Finger probe test is useful in the diagnosis of necrotizing fasciitis.

Procedure

• 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"