Necrotising Fasciitis – A Brief Layman’s Guide

Introduction

One of the most traumatic conditions we come across in handling clinical negligence compensation claims are those involving necrotizing fasciitis. This is also known as the ‘flesh-eating’ bug. It can be contracted in a variety of ways (not necessarily through medical negligence such as hospital-acquired infection) and is, thankfully, uncommon. Once it has been contracted, however, its progression is often rapid and the consequences can be devastating. If you suspect that someone you know is at risk from this condition, it is vital that they seek immediate medical treatment.

What is it?

Necrotising fasciitis is caused by certain types of bacteria. There are several types of this condition and various bacteria can cause it – including Streptococcus pyrogenes and Streptococcus aureus. The bacteria will often be present quite safely in another part of your body. Necrotizing fasciitis starts when some of these bacteria infect another part of the body which has a reduced resistance to their presence. Dressed wounds are common problem areas because these bacteria thrive in anaerobic (oxygen-free) environments. If left untreated, the bacteria multiply quickly leaving dead (or ‘necrotized’) tissue below the skin (in the layer called the ‘fascia’).

What are the signs?

The signs of worsening infection are often clear but can be open to differing interpretations by your treating doctor. This is not necessarily wrong and can lead to difficulties arising in pursuing a claim for compensation, particularly if clear medical records are not kept at the time. You can help by telling the doctor or nurse about:

• Immediate trauma;
• Discomfort developing quickly in the general region of the trauma;
• Pain which seems to be out of proportion with (or in a different area to) the location of the trauma;
• Signs of infection (such as a high temperature, disorientation, flu-like symptoms, vomiting, diarrhoea, dehydration, fever, malaise, weakness and/or muscle pain);
• Areas of broken skin (such as pressure sores);
• Discoloured skin (possibly red or black) around the infected area;
• A particularly unpleasant smell coming from the infected area;
• Large, boil-like blisters (which may bleed or ooze pus);
• A rapid deterioration in the person’s condition; or
• Gangrene.

Not all of these symptoms will be present in every case and each of them can be caused by entirely different conditions. However, it may help if you tell the treating medical staff about any symptoms you are concerned about although we do not advise you to attempt to tell the treating health professionals what to do. Keeping a note of your questions and the responses you receive can often help later (particularly in emergency situations).

You can help to prevent a possible misdiagnosis by giving a clear history of the patient’s previous medical history and any medication they are receiving. In one case we recently won, the correct diagnosis was only made when the Claimant’s wife tracked down her husband’s usual doctor in another part of the hospital and insisted that she come and see her husband even though this doctor no longer had responsibility for her husband’s care. Fortunately, this doctor immediately recognised the infection for what it was and the gentleman’s life was saved.

Consequences

Whilst the consequences are often dependent on the bacterium responsible, they are usually dramatic and severe. Necrotizing fasciitis may not necessarily result from the bacterial infection and other conditions can include rheumatic fever, toxic shock syndrome, ‘strep throat’ and acne.

In terms of necrotizing fasciitis, immediate emergency surgery (called ‘debridement’) is often the only way to stop the spread of the infection. A properly experienced surgeon will need to cut away both the infected tissue and uninfected tissue (from the area surrounding the infection). How much tissue needs to be cut out will likely require careful consideration by the surgeon and different surgeons may have different views. A strong course of antibiotics will often also be prescribed. The medical staff must still act within an acceptable range of medical opinion in providing the treatment.

Even if the treatment successfully kills the infection, the patient may suffer severe consequences. For example, the amount of tissue that is cut away may leave the patient badly scarred or largely immobile. Unfortunately, necrotizing fasciitis can be fatal. In such cases, we can assist you compassionately with an inquest or with a fatal accidents claim for compensation.

Conclusion

As with any medical condition, it is important not to jump to the wrong conclusion. Doctors are highly trained and cases of negligence are rare – we do not have a ‘compensation culture’ in the UK. Sometimes things do go wrong, however, and you should be prepared for this. In those circumstances, it may be appropriate to seek compensation after trying the official NHS Complaints Procedure. Legal Aid may be available to help you with the legal costs involved in investigating and pursuing a claim for compensation.

If you require additional information then we shall be happy to assist. Please bear in mind that this is a condition where prevention is definitely better than cure.

For further information, please contact:

Geoff Simpson-Scott
E-mail: Geoffrey.simpson-scott@colemans-ctts.co.uk
Direct dial: 0208 394 6581