Necrotizing Fasciitis

Necrotizing fasciitis (NF) of the female vulva and perineum is a life-threatening soft tissue infection. Risk factors include diabetes mellitus, obesity, immunosuppression, intravenous drug and alcohol abuse, trauma, and postoperative surgical wound complication, mainly by group A streptococcus. Diagnosis is timely if the clinician maintains a high index of suspicion for timely diagnosis. Clinical manifestations of NF can be vague, such as tissue erythema, edema, and pain and tenderness out of proportion to clinical exam. The fascial layer undergoes extensive necrosis. Examinations may reveal lack of tissue resistance upon probing, crepitus, skin necrosis, anesthesia, and skin discoloration. In CT scan, fascial edema and increased enhancement may be depicted, as well as subcutaneous air. MRI has high sensitivity for detecting NF. Prompt surgical debridement includes all devitalized tissue. In addition to electrolyte replacement and fluid resuscitation, patients have a better chance of recovery if transferred to intensive critical care unit.