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| Fig. 64.4 Necrotizing fasciitis. The typical well-demarcated, dusky purpuric lesion is caused by thrombosis of the involved vessels. |
The bacteria usually enter through a surgical or traumatic wound and quickly move along fascial planes destroying vessels and tissue. Within the first 48 hours, the involved area that is initially erythematous, indurated, and painful becomes a dusky blue, indicating lack of circulation in the area (Fig. 64-4). Because there is significant vessel thrombosis, a biopsy usually results in little or no bleeding, and this is a useful diagnostic sign if present. Surgical debridement in addition to systemic antibiotics is necessary and often reveals extensive covert tissue necrosis.
