fasciitis

Introduction

Inflammation of fascia

Etiology

• contaminated trauma
• etiologic agents (bacterial fasciitis)
  • Clostridium perfringens
  • group A streptococcus
  • mixed anaerobic & aerobic organisms (trauma)
    • Staphylococcus aureus
  • gram negative rods in diabetics
  • Bacillus cereus
  • Vibrio vulnificus

Pathology

• occurs together with localized myositis
• necrotizing fasciitis involves deep tissue planes

Clinical manifestations

• patient may appear extremely toxic
• rapid deterioration of clinical status may occur
• severe pain & swelling
• early signs of necrotizing fasciitis may not be apparent on the surface of the skin
• crepitus occurs with gas gangrene

Laboratory

• complete blood count: leukocytosis
• gram stain of deep tissue

Radiology

• plain radiographs may show gas tracking into muscle if there is associated myonecrosis
• computed tomography (CT) or magnetic resonance imaging (MRI) show:
  • muscle swelling
  • fluid collections in muscle compartments
  • gas

Management

• antibiotics
  • penicillin plus clindamycin
• surgical debridement
• hyperbaric oxygen for anaerobes

More general terms

• inflammation
• musculoskeletal disease/disorder

More specific terms

• eosinophilic fasciitis (Shulman's syndrome)
• Fournier's gangrene
• gas gangrene (anaerobic cellulitis)
• necrotizing fasciitis
• plantar fasciitis

Additional terms

• myositis (inflammatory myopathy)