Sonographic exploration for fascial exploration (SEFE) in necrotizing fasciitis: a case report

BACKGROUND: Necrotizing skin and soft tissue infections are life-threatening conditions. Reliance on gas in tissue planes leads to worsened outcomes in patients with non-gas forming types of necrotizing fasciitis (NF). CASE PRESENTATION: We present a case of Group A Strep (GAS) necrotizing fasciitis, which was identified at bedside with point-of-care ultrasound (US) including an area of subfascial fluid. Computerized tomography only revealed diffuse cellulitic changes. Patient was taken to the operating room where fascial exploration was not performed at the concerning area seen on ultrasound and thus falsely negative. The patient subsequently developed multi-system organ failure and required amputation of the limb due to rapid spread of GAS NF. CONCLUSION: We suggest an US protocol to help identify optimal areas for fascial exploration—sonographic exploration for fascial exploration (SEFE).