Flesheating

Flesheating is a colloquial term for necrotizing fasciitis, a rare but life-threatening bacterial infection that rapidly destroys fascia and surrounding soft tissue. It is a surgical emergency, and survival depends on prompt recognition and swift treatment. The infection can be monomicrobial, most often involving Group A Streptococcus, or polymicrobial, involving a mix of aerobic and anaerobic bacteria. Less commonly, Clostridium species or Vibrio and other organisms may be implicated.

Most cases begin after a minor skin breach such as a cut, abrasion, surgery, or another infection, but the entry point can be minor or occult. Risk factors include diabetes, immune suppression, chronic kidney or liver disease, vascular disease, obesity, alcoholism, malignancy, and intravenous drug use. The disease can progress rapidly, with tissue death extending along fascial planes.

Early symptoms typically include severe pain that is disproportionate to visible skin findings, swelling, and fever. Redness and warmth may progress to skin discoloration, bullae, and crepitus in gas-forming infections. Systemic signs such as hypotension, confusion, and organ dysfunction may develop as the illness advances.

Diagnosis relies on high clinical suspicion, supported by imaging and laboratory data. CT or MRI can reveal deep tissue edema; however, surgical exploration with debridement is definitive. Laboratory tests often show leukocytosis, elevated C-reactive protein, hyponatremia, and elevated creatinine; the LRINEC score has limited utility.

Treatment requires immediate broad-spectrum intravenous antibiotics and urgent surgical debridement, with multiple operations sometimes needed. Supportive care in an intensive care setting is common. Adjunctive therapies, such as hyperbaric oxygen, are considered on a case-by-case basis.

Prognosis depends heavily on time to treatment; mortality remains substantial even with aggressive care. Prevention centers on prompt wound care and early medical evaluation for rapidly spreading pain, especially in high-risk individuals, to enable timely intervention.