Abscess and Necrotising Fasciitis
Necrotising soft tissue infections, such as necrotising fasciitis, can be caused by an abscess. In this article we explore the link between abscesses and necrotising fasciitis, explaining what each condition is and they arise.
Abscess
An abscess is a collection of pus that develops underneath the skin (skin abscess) or inside the body (an internal abscess). They can also appear under a tooth or gum, which is known as a dental abscess.
An abscess happens as a result of a bacterial infection. When 'bad' bacteria get into the body, the immune system kicks in, sending white blood cells to the site of infection. The white blood cells destroy the bacteria, although in the process some of the surrounding tissue also dies. This forms a crater, into which bits of tissue, bacteria and cells fall. This is known collectively as pus.
The pus-filled cavity is an abscess. If it develops underneath the skin, it may be visible to the naked eye and will create a hard lump that can be felt. If it develops inside the body, it can be harder to detect, but is usually apparent due to the accompanying symptoms.
Some types of abscess have been given their own name. For instance, a Bartholin's abscess is when pus develops in one of the Bartholin's glands, which sit either side of the vaginal opening.
Who gets an abscess?
Anyone can get an abscess, as it is a potential side-effect of the body's response to a bacterial infection. However, it must be stressed that not everyone who has a bacterial infection will develop an abscess.
There are certain factors that can increase the risk. These include:
- Having a condition that weakens the immune system, such as HIV
- Having treatment that weakens the immune system, such as chemotherapy
- Having an inflammatory condition, such as inflammatory bowel disease
- Having diabetes
Treating an abscess
The treatment required depends upon the size and nature of the abscess. Some very small abscesses will heal of their accord without any medical intervention. Most patients will at least require a course of antibiotics to stop the infection spreading.
Antibiotics alone will not resolve larger abscesses. These will need to be drained, either by cutting it open or with a fine needle.
Failure to treat an abscess
It is important that an abscess is treated appropriately. While it may be acceptable to leave a small abscess to see if it will heal, it is not acceptable to leave a large abscess. Large abscess must be drained and antibiotics prescribed. This action must also be taken if a smaller abscess does not respond to antibiotics, or do not heal of their own accord.
Failing to treat an abscess can be very dangerous as the infection can escalate. The bacteria inside the abscess will reproduce and they will spread to a greater area. If a necrotising soft tissue infection is present, the bacteria will kill the surrounding tissue.
Necrotising fasciitis
Necrotising fasciitis is a type of soft tissue infection that can arise as a result of an abscess.
In the early stages of infection there will be palpable crepitus, which is a crackling noise made by air in the deep tissues. At this point the abscess will be verging on necrotising fasciitis. The plan must be for surgery with incision and drainage as soon as possible. A request must also be made for the vascular surgical team to review the patient.
If surgery is not performed to remove all the dead tissue, the infection will progress. Dark fluid will come from the site with surrounding redness. The patient must be reviewed and advice must be taken from a senior surgeon. If a senior opinion is not sought, there will be a breach of duty.
Fatal complications of necrotising fasciitis
If surgery is still not carried out, the wound will deteriorate. The patient may become so unwell that surgery will become positively dangerous. When debridement is finally done, consideration will need to be given to issues such as inotropic support (blood pressure support), cardiopulmonary resuscitation, treatment with intubation and ventilation.
Because of the risks involved at this stage, the patient may be asked before the procedure whether they want to make a 'do not resuscitate order'. If the patient is lacking mental capacity, their family will be asked instead.
During the operation, the surgeons must attempt to debride the necrotic tissue. However, if it is not possible to fully debride (resect) the dead tissue, it may be deemed that the lesion is not treatable. If a patient has made a do not resuscitate order, or has said they do not want treatment in intensive care, the debridement may be stopped. The patient will be made comfortable, but ultimately will not survive.
Long-term consequences of necrotising fasciitis
Even if a patient does survive necrotising fasciitis, it is likely that the delays in treatment will have caused severe long-term effects. Usually a large amount of tissue will have been removed, and this can lead to extensive scarring and pain. It will take a long time for the wound to close and ongoing medical care will be needed for months after the patient is discharged from hospital.
Depending upon the site of the abscess, there may also be some dysfunction. For instance, a rectal abscess that is not treated may lead to a large part of the bowel and rectum being removed. The patient will then require a permanent stoma.
Abscess necrotising fasciitis claims
If you or your loved one had an abscess that was not treated, resulting in necrotising fasciitis, there could be a case of medical negligence. Medical practitioners should treat an abscess with drainage and antibiotics. Smaller abscesses may be left, but even then they should be closely monitored and action taken if the abscess is not improving.
If an abscess is not appropriately treated, and this causes a severe infection such as necrotising fasciitis, the standard of care will be unacceptable. The patient or their family may be entitled to pursue a claim against those at fault. For more information on making a compensation claim, please get in touch with us today.
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