Image of the Day 27: Necrotizing Fasciitis of the Right Lower Limb due to Neglected Wound

40 years old gentleman involved in self motor vehicle accident in which he was a motorcycle rider and fell into a dried drain. He only sought medical attention four days after the event, after noticing the worsening of his leg condition which associated with foul smelling discharge, high grade fever and generalized body weakness.

On examination, he was conscious and alert but appears toxic and weak. Blood pressure is 104/72, pulse rate 116, Dextrostik is 3.7 and SPO2 under room air is 100%. Examination of the cardiovascular, respiratory and abdomen are normal.

Examination of the right leg shows wet gangrene involving the ankle region up to knee region with foul smelling discharge, ulceration and very weak peripheral pulses. Slip test is positive.

The radiography images of the right lower limb shows soft tissue swelling, subcutaneous air and  multiple dense opacification of the tissue which can represent pus.

A diagnosis of necrotizing fasciitis of the right lower limb with possibility of clostridial gas gangrene was made. He was stabilized and planned for emergency above knee amputation.

Gross appearance of the right leg

arrow shows multiple gas layer

air under the subcutaneous tissue.

Comment:

This case is a direct forward case as patient presenting very late. For a skin infection involving small region of the body, you may use a score called LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score. A score of more than 6 is indicative of necrotizing fasciitis. You can download the paper through this link

http://waesthetics.com/pdf/published/10.pdf