A 72-year-old woman undergoes elective right hemicolectomy. On post-operative day 5, she develops a wound infection with erythema extending from the wound edges in a woody hard pattern across the abdominal wall, crepitus, and systemic sepsis. The diagnosis and management are:

• A Superficial wound dehiscence — repack and secondary healing
• B Necrotising fasciitis — emergency surgical debridement, broad-spectrum IV antibiotics, ITU support ✓
• C Cellulitis — IV flucloxacillin for 7 days
• D Deep space abscess — ultrasound-guided percutaneous drainage

Explanation

Woody induration, crepitus, and rapidly spreading erythema with systemic sepsis after surgery are hallmark features of necrotising fasciitis — a surgical emergency with 25–35% mortality. Crepitus indicates gas-forming organisms (Type I polymicrobial or Type II Group A Streptococcus). Treatment is immediate wide surgical debridement of all affected fascia, repeated 'second-look' debridements at 24–48h, broad-spectrum antibiotics (piperacillin-tazobactam + clindamycin ± penicillin for streptococcal cover), and ICU management. Delay in surgical debridement is the primary cause of mortality. Cellulitis does not produce crepitus and systemic sepsis of this severity.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.