Necrotizing fasciitis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]

Physical Examination

Common physical examination findings associated with necrotizing fasciitis may include:

Appearance of the patient

Patients with necrotizing fasciitis appear fatigued during early stages and may have altered mental status during late stages. In end stage necrotizing fasciitis, patients exhibit signs of septic shock.

Vital signs

• Fever (is often absent)
• Tachycardia
• Low blood pressure
• Tachypnea

Skin

• Jaundice
• Evidence of trauma, surgery, insect or human bites, or injection sites

Local examination

• Induration
• Warmth
• Tenderness beyond margins of erythema
• Swelling
• Erythema with ill defined margins
• Blistering/bullae
• Skin discoloration
• Foul discharge (greyish or brown discharge)
• Fluctuance
• Crepitus
• Skin sloughing or necrosis
• Absence of lymphangiitis or lymphadenopathy
• Sensory and motor deficits (e.g. localized anesthesia)

Stage 1 (Early)	Stage 2 (Intermediate)	Stage 3 (Late)
Tenderness to palpation (extending beyond the apparent area of skin involvement) Erythema Swelling Warm to palpation	Blister or bullae formation (serous fluid) Skin fluctuance Skin induration	Hemorrhagic bullae Skin anesthesia Crepitus Skin necrosis with dusky discoloration progressing to frank gangrene