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Investigations

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Investigations to support the clinical diagnosis of necrotising fasciitis include:

  • blood tests:
    • leucocytosis
    • raised urea and creatinine
    • hypoalbuminaemia
    • acidosis
    • altered coagulation profile
  • microbiology
    • send blood for culture and debrided tissues for culture and gram stain (1)
  • imaging
    • plain radiography
    • soft tissue gas eg due to clostridial myonecrosis
    • foreign bodies
    • CT or MRI
  • bedside investigations
    • “finger sweep test”
    • under local anaesthetic, a small incision is made down to the deep fascia. Gentle probing with the index finger is performed at the level of the deep fascia. A positive test is indicated when there is
      • lack of resistance to finger dissection
      • lack of bleeding
      • release of ‘dishwater fluid’ - an offensive, brown-coloured fluid
    • incisional biopsy and an immediate frozen section, culture and gram stain (2)

Reference:

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