<P> Intravenous immunoglobulin is considered for the treatment of necrotising soft tissue infection . This is because the immunglobulins can bind to the exotoxins produced by Streptococcal and Staphylococcal infections, which subsequently limits immune response of the human body . However, there is limited data on the efficacy of this therapy . Therefore, such therapy is limited only for those who are critically ill . </P> <P> Wound dressings applied on the should allow for ambulation in order to prevent hospital acquired pneumonia, urinary tract infection, and deep vein thrombosis . The use of Mafenide (2.5 or 5% dilution) or Dakin solution, pulse lavage (wound irrigation using pressurised jets of normal saline to remove fibrinous material and bacteria), and negative - pressure wound therapy (vacuum dressing; promotes vascularisation of wound bed). Wound closure should be delayed if there is hypoperfusion of the tissues due to hypotension . Wound closure can be started once the wound bed is clean with good tissue perfusion . </P> <P> Pain control is another important modality in wound management as pain can affect wound healing . The severity of pain can be assessed by Wong - Baker Faces Pain Rating Scale and Numeric Rating Scale according to the age and cultural background of the those in pain . Pain can be divided into three types: background pain, breakthrough pain, and procedural pain . Background pain is relatively constant and may be started before the onset of necrotising fasciitis which can range from mild to moderate pain . Such pain can be treated by methadone . Breakthough pain is the sudden worsening of pain in addition to background pain which is precipitated by movements or emotions . This type of pain can be treated by morphine, or oxycodone with combination of nonsteroidal anti-inflammatory drug (NSAID). Procedural pain the intense burning or stinging pain when procedures are performed such as wound debridement, changing of dressings, or physiotherapy . Morphine or oxycodone, in combination with short acting anxiolytic drugs such as midazolam and lorazepam . Gabapentin, an anticonvulsant, can be used to control neuropathic pain in surgical debridements and ampuatations . Skin graft and tissue rearrangement can be used to achieve wound closure . </P> <P> Necrotizing fasciitis affects about 0.4 in every 100,000 people per year in the United States . There were about 1,000 cases of necrotising fasciitis cases per year in the United States, however, the rates have been increasing . This could be due to increasing awareness of this condition, leading to increased reporting, or there could be increasing bacterial virulence, or increasing bacterial resistance against antibiotics . In some areas of the world it is as common as 1 in every 100,000 people . </P>

Where can necrotizing fasciitis be found in the world