Necrotizing fasciitis In recent years necrotizing fasciitis

Necrotizing fasciitis
In recent years, necrotizing fasciitis has gained notoriety in the news media as the “flesh-eating
bacteria” infection, but this type of massive bacterial infection resulting in tissue necrosis may be
caused by a variety of aggressive strains of common bacteria. Moreover, necrotizing fasciitis
comes in several subtypes with some subtypes well documented in medical literature from at
least as far back as the American Civil War when doctors documented cases, which they termed
gangrene. In fact, gas gangrene may be classified as a subtype of necrotizing fasciitis.
Necrotizing fasciitis may frequently involve hemolytic Streptoccocus entering enter the
superficial fascia via a wound in the skin, but there are also cases of multi-bacterial necrotizing
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fasciitis. Bacterial colonization spreads rapidly along fascial planes of the body, which results in
extensive necrosis of the superficial fascia and in the spread of the infection into the deep
fasciae. Although the infection is usually limited to the fasciae, the skin readily separates from
the underlying muscle, and skin necrosis occurs due to destruction of blood vessels within the
superficial fasciae. Advanced, untreated infections may spread to skeletal-muscle tissue,
resulting in muscle necrosis. Septicemia is common because bacterial entry into the blood results
in systemic bacterial infection.
The infection’s aggressive and rapid spread along fascial planes is not readily countered by
antibiotics, and the only recourse available to many patients is to surgically remove the infected
tissue and to concurrently issue a regimen of broad-spectrum, high-dosage antibiotics. When
large areas of skin are lost, skin grafting is necessitated. The end result of surgical treatment by
removal of skin, fasciae, and muscle is disfigurement that requires rebuilding by a plastic
surgeon.

Describe the anatomy of the superficial and deep fasciae and discuss how the anatomy is related
to the above-described pattern of signs/symptoms.

Solution

Superficial fascia:

This is the lower most layer of the skin. It is present below dermis. Mostly it blends with the dermis. It is present in all regions of the body.

Deep fascia:

This is a layer of connective tissue which surrounds individual muscles. It contains large amount of elastin fibers; which gives high elasticity to this tissue. It does not contain any blood vessels. Sensory receptors are present. It is found in the muscles of leg, thigh, arms and penis. Fascial planes are formed in our body because of deep fascia.

The anatomy of these two fascias is related to the work performed by flesh eating bacteria. Flesh eating bacteria are the causal agent of necrotizing fasciitis in our body.

Please note that the symptoms given are \"skin readily separates from the underlying muscle, and skin necrosis occurs due to destruction of blood vessels within the superficial fasciae\". Anatomy of superficial fascia is responsible for this destruction. Bacterial infect our body first via blood; and reaches the superficial fascia via blood vessels. It is important to note that if the anatomy of both type of fascia discussed above had been opposite, then, these symptoms wouldn\'t have had appeared. Suppose superficial fascia lacked blood vessels, then skin necrosis would not occur in the similar manner, as described in the question.

After this, the infection moves towards the fascial planes, in the deep fascia. At this stage, antibiotic treatment is not effective any more. This is because large and important areas of skin (i.e. dermis) have already been lost.