‘Killer’ skin infection leads to legal dispute       

Dr David Gregg  II  DEC 14 2016

An Essex man is to sue Southend Hospital after he contracted a life-threatening infection, necrotising fasciitis (NF), ending in the loss of his penis and part of his abdominal wall. Mr Andrew Lane, 61, says his bowel was damaged during an operation on his prostate in 2013, after which he had to use a catheter and a colostomy bag for two years. Mr Lane hopes by talking about his experiences, he will be able to prevent others going through the same. Southend Hospital Foundation Trust is declining to comment on the case due to ongoing legal processes.

NF is a rare and serious infection, often wrongly described as ‘flesh-eating’. Bacteria, usually multiple species, spread along fascia, planes of connective tissue which enclose and separate muscles from fat. The bacteria spread rapidly, releasing deadly toxins causing death and destruction of the surrounding tissue. This destruction is much more extensive than would be guessed by looking at the skin, which often only has a small patch of redness. NF is most common in the limbs, or around the genitals, when it is known as Fournier’s gangrene.

Most cases of NF occur in healthy people from bacteria that live in the gut, throat or skin. To cause NF, these bacteria need to be introduced to the bloodstream, or directly to soft tissue. This can occur from any kind of wound, from a trivial scratch to a surgical bowel perforation. There are around 1,000 cases of NF per year in the UK.

One of the difficulties doctors have diagnosing NF is it is very difficult to spot. A red rash along with a fever could be ‘skin infection’, flu or stomach bug; all of which are vastly more common than NF. Most doctors will not see enough cases of NF to be familiar with the signs and symptoms of it.  Unfortunately, unless NF is treated early, it can have tragic consequences. Even with the best available care, 1 in 5 people with NF die of multiple organ failure.

NF is treated urgently with intravenous broad-spectrum antibiotics, and surgical removal of a large area of surrounding tissues to prevent spread and recurrence. This removal, or debridement, is often extremely extensive, and can result in the need for multiple cosmetic procedures to correct the appearance of the area.
While stories such as Mr Lane’s are tragic, and make good headlines for newspapers, they are thankfully rare. NF following a surgical bowel perforation is described in only a few case reports worldwide. The vast majority of those who have prostate surgery don’t have a bowel perforation, and even in those that do, NF is vanishingly rare.

Good hand hygiene and wound care by those who’ve had surgery reduces the already small risk of NF even further.

Any opinions above are the author's alone and may not represent those of the NHS or Mind and Medicine. Any comment is based on the best available evidence at the time of writing.  All data is based on externally validated studies unless expressed otherwise. Novel data is representative of sample surveyed. Online recommendation is no substitute for seeing your own doctor and should not be taken as medical advice.