Severe necrotizing soft-tissue infections. Multiple disease entities requiring a common approach

JAMA. 1981 Oct 9;246(15):1717-21.

Abstract

The spectrum of severe soft-tissue surgical infections extends from synergistic necrotizing soft-tissue infections to histotoxic clostridial infections. These syndromes may demonstrate dramatic destruction of underlying tissue far out of proportion to the external evidence for infection, although a marked systemic response in common. The differential diagnosis hinges on the clinical presentation, the Gram's stain, and operative inspection. More important than the precise label placed on a given case is the early recognition of the urgent surgical nature of the infection. Signs indicating a rapidly spreading soft-tissue infection mandate fluid resuscitation, broad-spectrum antibiotics, and early operative exploration with aggressive debridement. These are highly lethal infections in which timely recognition and effective management may be lifesaving.

MeSH terms

  • Aerobiosis
  • Anaerobiosis
  • Bacterial Infections*
  • Clostridium Infections*
  • Humans
  • Muscles / pathology
  • Muscular Diseases / etiology*
  • Necrosis
  • Surgical Wound Infection / etiology*
  • Surgical Wound Infection / surgery
  • Surgical Wound Infection / therapy