This book describes the Necrotizing Fasciitis, Diagnosis and Treatment and Related Diseases
I had a Malay female patient who used to see me for minor coughs and cold.
She was 50 years old and was walking through a grass area bringing her grandson to school when she developed rashes on her right leg.
That very night she developed high fever so her children sent her to hospital.
In the hospital her rash on her right spread quickly and become ulcerating.
The doctors there had to do emergency surgery to remove the infected flesh in order to save her leg.
The tissues removed were sent for microscopic examination and culture.
The cause was necrotizing fasciliitis or flesh eating disease.
She was eventually discharged after 1 month after the wound healed leaving a long hole in her leg where the muscles were removed.
Her life was saved as a result of the emergency surgery but the deep hollow in her leg would always remind her of her ordeal.
That was 15 years ago and her grandson is already 22 years old and working.
She passed away from a heart attack 5 years ago.
It was a frightening experience for her and her grandson.
It was my first and last case of necrotizing fasciliitis seen by me in my 45 years of practice as a doctor.
Necrotizing Fasciitis is a rare medical disorder that is caused by a very severe type of bacterial infection.
It can injure the muscles, skin, and underlying tissue.
The word "necrotizing" indicates something that causes body tissue to die.
Necrotizing fasciitis (NF) is an infrequent but life-threatening infection.
It is described as a destructive infection affecting any layer of the deep soft tissue compartment (dermis, subcutaneous tissue, fascia or muscle)
1. Necrotizing fasciitis is difficult to diagnose in its early stages, as it imitates cellulitis.
2. Important early signs are:
b. Tenderness and
c. Systemic illness out of proportion to the localized physical signs
3. Bullae and ecchymotic skin lesions also indicate the condition (not found with cellulitis).
4. A high index of suspicion is required.
5. Suspected cases should be referred immediately.
6. Prompt surgical debridement is important.
A high index of suspicion is required when a patient manifests with cutaneous infection causing swelling, pain and erythema, especially if the patient also has diabetes, malignancy, alcohol abuse, or chronic liver or kidney disease.
The presence of bullae or gas on plain X-ray can be diagnostic.
Early surgical exploration is advised when there is any uncertainty of the diagnosis.
During surgery, the diagnosis of NF is made on its macroscopic features, which are:
1. Grey necrotic tissue,
2. Lack of bleeding,
3. Thrombosed vessels,
4. 'Dishwater pus',
5. Lack of resistance to finger dissection
6. Non-contracting muscle
The following tests may help to identify necrotizing infection where the medical picture is uncertain.
1. Blood tests - may show leukocytosis, acidosis, altered coagulation profile, hypoalbuminaemia and abnormal renal function.
2. Bedside finger test:
This is carried out under local anesthesia.
TABLE OF CONTENT
Chapter 1 Necrotizing Fasciitis
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Cellulitis
Chapter 8 Abscess
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About the Author
Medical doctor since 1972. Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009. Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993. Dr Kenneth Kee is still working as a family doctor at the age of 65. However he has reduced his consultation hours to 3 hours in the morning and 2 hours in the afternoon. He first started writing free blogs on medical conditions seen in the clinic in 2007 on http://kennethkee.blogspot.com. His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog afamilydoctorstale.blogspot.com. This autobiolographical account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Conditions” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com. From which many free articles from the blog was taken and put together into 550 amazon kindle books and some into Smashwords.com eBooks. He apologized for typos and spelling mistakes in his earlier books. He will endeavor to improve the writing in futures. Some people have complained that the simple guides are too simple. For their information they are made simple in order to educate the patients. The later books go into more details of medical conditions. The first chapter of all my ebooks is always taken from my blog A Simple Guide to Medical Conditions which was started in 2007 as a simple educational help to my patients on my first blog http://kennethkee.blogspot.com. The medical condition was described simply and direct to the point. Because the simple guide as taken from the blog was described as too simple, I have increased the other chapters to include more detailed description of the illness, symptoms, diagnosis and treatment. As a result there are the complaints by some readers of constant repetitions of the same contents but in detail and fairly up to date. He has published 550 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter. The purpose of these simple guides is to educate patient on health conditions and not meant as textbooks. He does not do any night duty since 2000 ever since Dr Tan had his second stroke. His clinic is now relocated to the Bouna Vista Community Centre. The 2 units of his original clinic are being demolished to make way for a new Shopping Mall. He is now doing some blogging and internet surfing (bulletin boards since the 1980's) starting with the Apple computer and going to PC. All the PC is upgraded by himself from XT to the present Pentium duo core. The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive. He is also into DIY changing his own toilet cistern and other electric appliance. His hunger for knowledge has not abated and he is a lifelong learner. The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned. This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale. Dr Kee is the author of: "A Family Doctor's Tale" "Life Lessons Learned From The Study And Practice Of Medicine" "Case Notes From A Family Doctor"