fasciitis
(fash‵ē-īt'ĭs 
, fas‵ē-īt'ĭs)
[fascia + -itis]
Inflammation of a fascia.
eosinophilic f.A frequently painful inflammation of muscle fascia, along with overlying contracture of the skin, esp. on the medial surface of the upper arms. Eosinophilia is present in most affected patients. SYN: Shulman syndrome.
ABBR: NF
A severe bacterial infection that spreads rapidly through the body along superficial or deep fascial planes, resulting in necrosis of subcutaneous tissue and extensive undermining. SYN: hospital gangrene.NF is an uncommon disease. In the U.S. it is identified in 4 individuals per million population/year.
The onset of NF is usually acute and progression rapid. Initially there is severe pain (out of proportion to the injury), swelling at the injury site, fever, chills, and flulike symptoms or malaise. These symptoms worsen as the infection spreads. If extensive surgical débridement, drainage, and antibiotics are not instituted early, the patient may die.
Bacteria most commonly responsible are invasive group A hemolytic streptococci, Staphylococcus aureus, Clostridium perfringens, oral flora (as after a bite), enteric flora, coliforms, proteus, pseudomonas, klebsiella, and Vibrio vulnificus (particularly in alcoholics, diabetics, and the immunocompromised). The size of the wound that gives these bacteria access to the subcutaneous tissue is not related to the severity of infection. Predisposing factors include surgical or traumatic wounds (including those with foreign bodies), drug injections (particularly contaminated drugs of abuse), burns, frostbite, insect bites, and other skin lesions (open sores or varicella). Those with diabetes, cancer, alcoholism, obesity, or malnutrition are at increased risk.
Emergency surgical débridement is required.
Health care professionals should maintain contact and stand ard precautions, administer oxygen, establish an IV access (avoiding use of the infected extremity), obtain specimens for blood studies (complete blood count and differential, electrolytes, glucose, blood urea nitrogen, creatinine, and arterial blood gas specimens), urinalysis, and cultures (wound tissue specimens are collected during debridement). IV fluids and antibiotics and analgesics are administered as prescribed. Cardiac monitoring is initiated, and an indwelling urinary catheter inserted (unless the infection involved the perineal area). The patient also may require imaging studies (x-rays, CT, MRI) to assess for gas and necrosis in subcutaneous facial planes. Hyperbaric oxygen therapy, when combined with antibiotic and surgical débridement, helps to promote healing by encouraging growth of epithelial tissue and blood vessels.
Patient care also includes frequent assessment of the patient and lab values for indications of life-threatening complications (sepsis, gangrene, coagulation disorders, multiple organ dysfunction). The infection site should be monitored continually for changes such as edema, color changes, and increased or decreased pain (anesthesia). The patient’s pain should be documented using a stand ard pain-rating scale. Opioids or opiates should be provided as indicated, particularly during painful dressing changes. Patient-controlled analgesia with added drugs for break-through pain may be appropriate. A nutritionist should ensure that the patient’s caloric and nutrient intake is sufficient to support wound healing. Enteral feeding may be needed. Ongoing emotional support should be provided to the patient and family, as they confront the possibility of death, and the threat of amputation or disfigurement, knowing that further surgery and extensive skin grafting may be required in the future. The patient should be assessed for depression and anxiety, given information about rehabilitation, and encouraged to seek additional counseling to deal with role changes and body image issues.
SEE: Fournier gangrene.
plantar f.Painful inflammation of the heel and bottom surface of the foot caused by excessive stretching of the fascia that attaches the heel to the forefoot. It can be caused or exacerbated by excessive physical activity, improper footwear, obesity, or pregnancy.