Overview
Introduction: When the Skin Underestimates the Disease
A patient whose leg becomes exquisitely painful over a few hours, while the skin still shows only modest erythema, may have a much deeper process than cellulitis.
A patient whose leg becomes exquisitely painful over a few hours, while the skin still shows only modest erythema, may have a much deeper process than cellulitis. Necrotizing fasciitis advances through fascia and subcutaneous tissue; thrombosed small vessels and tissue necrosis can make the surface underestimate the speed and extent of disease. Treat a convincing pattern as an operative emergency. Immediate surgical consultation, resuscitation, and broad-spectrum intravenous antimicrobials proceed in parallel. A normal-looking area, a low LRINEC score, or a pending CT cannot safely overrule the bedside trajectory or delay source control.