Necrotizing fasciitis: review, recent concepts in etiopathogeny and diagnosis

Necrotizing fasciitis is part of the necrotizing infections of the soft tissues. It is a rare, but life-threatening condition, with different clinical manifestations and germs that progress in a similar way. In the musculoskeletal system this condition is mainly found in the limbs, its spreading is superficial and it causes local histic necrosis accompanied by severe systemic damage due to the release of bacterial toxins of Klebsiella, Clostridium, Escherichia coli, Staphylococcus aureus and Aeromonas hydrophila. However, group A Streptococcus is the commonest cause of the disease. The condition is presented with signs of pain and systemic toxicity, disproportionate to the findings of the cutaneous examination, what leads to suspect the presence of the disease. Even with an adequate treatment the condition has a high mortality. A bibliographic review article was carried out in order to bring concepts to date and highlight the recent progress in the study of necrotizing fasciitis. The following resources available in the Infomed network were used: PubMed, Hinari, The Cochrane Library and SciELO; MEDLINE and MedicLatina databases were accessed. Results of researches were compiled detailing the following contents: demography, comorbidities, epidemiology, classifications, etiology, mortality, diagnostic procedures, and biological and analytical risk indicators (LRINEC). There is controversy regarding the management, diagnostic procedures, results obtained with different procedures and there is no inter-observational uniformity. However, there is unanimous criterion concerning the special attention to be paid to clinical manifestations, advanced diagnosis and multidisciplinary care.