Necrotising Fasciitis Management

The successful global management of Necrotising Fasciitis (NF) is underpinned by urgent principles that are universal and hinge on a structured, three-pronged attack.

The three fundamental and non-negotiable principles underpinning successful global NF management are:

1. Urgent Resuscitation: Immediate aggressive fluid resuscitation for sepsis or septic shock is the first priority. This medical management is critical and is undertaken according to standard guidelines, such as the UK’s Sepsis Six or the US Surviving Sepsis Campaign. NF patients almost always require supportive care in an Intensive Care Unit (ICU) setting for close monitoring and potential inotropic or organ support.

2. Rapid Administration of Broad-Spectrum Intravenous Antibiotics: Antibiotics must be administered within the first hour of suspicion, after blood cultures have been taken. The regimen must be broad-spectrum to cover Gram-positive, Gram-negative, and anaerobic bacteria. Furthermore, Clindamycin is considered critical for its toxin-suppressing effect in Streptococcal and Staphylococcal infections.

3. Urgent Radical Surgical Debridement: The principles of surgery are explicitly stated as identical and non-negotiable across international guidelines. Surgical exploration is considered the gold standard for diagnosis and is simultaneously therapeutic. The primary goal is to control the source of infection by performing urgent radical debridement, which involves excising all necrotic tissue until healthy, bleeding tissue is encountered. This process necessitates "second look" operations within 12–24 hours, repeated until the infection is fully controlled and no further necrosis is found.

Let's dive in. 

Disclaimer: This is only for reference purposes and please refer to local guidelines in practice.