Risk factors for necrotizing fasciitis:
(1) diabetes mellitus
(2) chronic corticosteroid therapy
(3) other immunosuppressive therapy
(4) immunodeficiency
(5) malnutrition
Risk factors for localization to the abdominal wall:
(1) dislodged percutaneous gastrostomy tube
(2) recent abdominal trauma or surgery
(3) obesity
(4) perforated viscus (appendicitis, diverticulitis, other)
(5) subcutaneous drug injection
(6) incarcerated hernias
(7) enterocutaneous or colocutaneous fistula
Risk factors for delayed diagnosis:
(1) obtunded mental status
(2) limited nursing care
(3) narcotic analgesia
Clinical findings:
(1) high fever
(2) localized pain to the abdominal wall
(3) cellulitis over the abdominal wall
(4) edema of the abdominal wall
(5) subcutaneous emphysema over the abdominal wall, which may be best seen on X-rays
(6) sepsis, hypotension and multi-organ failure
Management includes:
(1) aggressive debridement of all nonviable tissue is of primary importance
(2) aggressive resuscitation
(3) control of underlying cause if possible
(4) antibiotic therapy
(5) plastic repair once disease controlled
