to provide additional evidence for infection if there is leukocytosis and gives a coarse index of the severity
platelets; thrombocytopaenia can be triggered by sepsis
clotting; may be abnormal in sepsis
blood cultures; if pyrexial
plain X-ray films; not particularly helpful but may show gas in the soft tissues or a foreign body
MRI and CT;
can indicate the extent of soft tissue swelling and/or gas in tissue planes
however, due to the time entailed by these imaging modalities, they are not indicated in the presence of a septic patient in whom the clinical picture strongly suggests Fourniere's Gangrene - debridement in theatre is mandated
biopsy of the fascia for diagnosis:
can be done at the bedside in a relatively well patient by incisional biopsy over an area of maximal fluctuance or tenderness
however, in the unwell patient a full debridement of clearly necrotic tissue and sending of samples taken with clean instruments is mandated
samples are sent for urgent microbiology and histology:
urgent gram stain can guide empirical initial antibiotics
histology can reveal the characteristic picture of:
fibrinoid necrosis of nutrient perforating arterioles to the skin
necrosis of superficial and deep fascia
neutrophil infiltrate
micro-organisms associated with the necrotic tissue
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