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Global Journal of Surgery. Volume 2, Issue 2 (2011) pp. 85-89
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Review Article
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Necrotizing soft tissue infections - A disease revisited
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Amit Kumar Shaha,*, Rajan Chaudhryb, SK Deshpandea, DK Kharea
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a Department of Surgery,158 Base Hospital, C/O 99 APO, India
b Command Hospital (Eastern Command), Kolkatta, India
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Abstract |
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Necrotizing soft tissue infections (NSTI) are relatively common infections in developing countries, and often present for medical attention late in their course. The diagnosis is often missed at initial presentation, allowing further progression of the infectious process. Initially, NSTI is manifested by severe pain localized at the trauma site. However, this is disproportionate to the physical findings, as skin usually doesn’t carry any infection signs. Patient presenting late in the course of the disease where sepsis has already set in, further complicates the initial management. Pathogenesis of severe NSTI is known to be multibacterial. Once the diagnosis of NSTI is made, treatment should be instituted promptly. Resuscitation, based on the clinical state of the patient, includes aggressive fluid replacement to manage acute renal failure from ongoing sepsis and shock. Empirical antibiotics, intensive support and aggressive surgical debridement forms the mainstay of treatment of NSTI. The degree of body area involvement, incomplete surgical debridement, WBC >15400/cmm, serum sodium < 135mEq/L and increased serum lactic acid > 54.1mg/dl at hospital admission has also been shown to increase mortality. In summary of the treatment options, we know that surgical debridement, rapid surgical debridement, is important. Outcomes are based on the promptness of diagnosis, surgical treatment, and the management of perioperative complications.
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Keywords |
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Necrotizing soft tissue infections (NSTI);Necrotizing fasciitis; Sepsis; Sebridement; Fournier's gangrene; Meleney's ulcers;LRINEC; GAS infections; Hyperbaric oxygen therapy
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