Necrotizing Soft Tissue Infections - 03/10/13

Doi : 10.1016/j.ccc.2013.06.001

Qaali A. Hussein, MD ^a, Daniel A. Anaya, MD ^a,^b,^c,^⁎
^a Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza (BCM390), Houston, TX 77030, USA
^b Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard (OCL 112), Houston, TX 77030, USA
^c Michael E. DeBakey Veterans Affairs Medical Center, Houston Veterans Affairs Health Services Research and Development Center of Excellence, Houston, TX, USA

^∗Corresponding author. 2002 Holcombe Boulevard (OCL 112), Houston, TX 77030.

Résumé

Necrotizing soft tissue infections (NSTIs) are infrequent yet highly lethal infections, and a high index of suspicion is required for early diagnosis. Diagnosing NSTIs early can be challenging, and knowledge of the available tools is essential to provide appropriate treatment. The mainstay of treatment is early and complete surgical debridement combined with antimicrobial therapy, close monitoring with further debridement as needed, and physiologic support. Mortality continues to be high, and delayed surgical treatment is the most important risk factor. For the long-term recovery of patients with NSTI, providing early physiologic and nutritional support and physical rehabilitation is essential.

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Keywords : Necrotizing soft tissue infections, NSTI, Necrotizing fasciitis, Gangrene, Clostridial infection, Group A streptococcal infection

Plan

Specific Clinical Clues

Laboratory Findings

Imaging Studies

Frozen Section Biopsy

Operative Exploration to Confirm Diagnosis

Antimicrobial management

Surgical indications and therapy

Funding Source: This material is the result of work supported with resources and the use of facilities at the Houston VA Health Services Research and Development Center of Excellence at the Michael E. DeBakey Veterans Affairs Medical Center (HFP90-020). None of the funding agencies played a role in the design and conduct of the study, analysis and interpretation of the data, or preparation and approval of the article. The views expressed are those of the authors and do not necessarily reflect those of the Department of Veterans Affairs, the US government, or Baylor College of Medicine.

Conflict of Interest: The authors have no financial conflict of interest to disclose.