Monitoring
While the patient is waiting for initial emergency debridement, monitor them for systemic toxicity (e.g., signs of end-organ damage), as well as local signs and symptoms of extension of the area of necrotising fasciitis.
Following the initial debridement, monitor the patient closely for decline in respiratory/haemodynamic function. Watch for the progression to toxic shock syndrome in patients with group A streptococcal infection. See Toxic shock syndrome.
Consider the need for additional debridement or alteration in antibiotic or antifungal therapy, based on culture results from subcutaneous tissue or blood, the patient’s clinical condition, and discussion with the multidisciplinary team.[53]
Surgical re-exploration to assess the need for further debridement should be performed at least every 12 to 24 hours after the initial debridement.[3]
However, re-exploration may be needed sooner in some patients; inform the surgical team urgently if the patient has clinical signs of worsening infection (local or systemic), or worsening laboratory markers (particularly white blood cell count).[3]
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