Source Control pp 208-215 | Cite as

Soft Tissue Infections

  • Seong K. Lee
  • Jan K. Horn


• Soft tissue infections can be classified as either simple or necrotizing. • Necrotizing soft tissue infections (NSTI) generally involve the subcutaneous tissue, fascia, or deeper tissues. Therefore, an NSTI may not be readily apparent on external inspection of the skin. • Patients with a history of blunt or penetrating trauma, diabetes mellitus, illicit parenteral drug use, burns, bites, stings, recent surgery, immunologic deficiency, or soft tissue contamination are at risk for NSTI. • Initial management of NSTI includes administration of antibiotics, hemodynamic monitoring and physiologic stabilization, treatment of electrolyte/acid-base imbalances, and correction of coagulopathy. • Treatment consists of urgent surgical exploration with drainage and debridement of nonviable or infected tissue. Wounds require frequent inspection until one is assured that tissues remain viable and infection is no longer spreading.


Soft Tissue Infection Necrotizing Fasciitis Hyperbaric Oxygen Therapy Fecal Diversion Clostridial Myonecrosis 
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  1. 1.
    Lewis RT (1998) Soft tissue infections. World J Surg 22:146–151 Classification of soft tissue infections including review of necrotizing soft tissue infections.PubMedCrossRefGoogle Scholar
  2. 2.
    Hill MK, Sanders CV (1998) Skin and soft tissue infections in critical care. Inf in Crit Care II 14:251–262 Review of bacteriology of infections occurring in the ICU.Google Scholar
  3. 3.
    Green RJ, Dafoe DC, Raffin TA (1996) Necrotizing fasciitis. Chest 110:219–229 Review of necrotizing fasciitis including figure reference and extensive bibliography.PubMedCrossRefGoogle Scholar
  4. 4.
    Singh G, Ray P, Sinha K, Adhikary S, Khanna SK (1996) Bacteriology of necrotizing infections of soft tissues. Aust NZ J Surg 66:747–750 Detailed bacterial profile of 55 patients with NSTI.CrossRefGoogle Scholar
  5. 5.
    Callahan TE, Schecter WP, Horn JK (1998) Necrotizing soft tissue infection masquerading as cutaneous abscess following illicit drug injection. Arch Surg 133:812–818 Retrospective analysis of 30 cases of NSTI from parenteral drug use.PubMedCrossRefGoogle Scholar
  6. 6.
    Bosshardt TL, Henderson VJ, Organ CH (1996) Necrotizing soft-tissue infections. Arch Surg 131:846–854 Review of 45 patients with NSTI demonstrating parenteral drug use as an increasing cause.PubMedCrossRefGoogle Scholar
  7. 7.
    Wall DB, De Virgilio C, Black S, Klein SR (2000) Objective criteria may assist in distinguishing necrotizing fasciitis from nonnecrotizing soft tissue infection. Am J Surg 179:17–21 Retrospective review of necrotizing vs. non-necrotizing soft tissue infections in which WBC > 14, serum Na < 135 and, BUN > 15 predicted NSTI.PubMedCrossRefGoogle Scholar
  8. 8.
    Bilton DB, Zibari GB, McMillan RW, Aultman DF, Dunn G, McDonald JC (1998) Aggressive surgical management of necrotizing fasciitis serves to decrease mortality: a retrospective study. Am Surg 64:397–401 Retrospective comparison of aggressive surgical debridement vs. delayed therapy demonstrating a significantly decreased mortality with aggressive therapy.PubMedGoogle Scholar
  9. 9.
    McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA (1995) Determinants of mortality for necrotizing soft-tissue infections. Ann Surg 221:558–565 Large review of NSTI with identification of delay to operation significantly increasing mortality. 10.PubMedCrossRefGoogle Scholar
  10. Francis.
    KR, Lamaute HR, Davis JM, Pizzi W (1993) Implications of risk factors in necrotizing fasciitis. Am Surg 59:304–308 Retrospective review of risk factors in patients with NSTI in which more than three factors increased mortality over 50%.PubMedGoogle Scholar
  11. 11.
    Ward RG, Walsh MS (1991) Necrotizing fasciitis: 10 year's experience in a district general hospital. Brit J Surg 78:488–489 Review of 14 patients with necrotizing fasciitis with analysis of factors involved with mortality.PubMedCrossRefGoogle Scholar
  12. 12.
    Giuliano A, Lewis F, Hadley K, Blaisdell FW (1977) Bacteriology of necrotizing fasciitis. Am J Surg 134:52–57 Classic review of 16 patients with necrotizing fasciitis with focus on bacteriology and culture results.PubMedCrossRefGoogle Scholar
  13. 13.
    Beauchamp NJ, Scott WW, Gottlieb LM, Fishman EK (1995) CT evaluation of soft tissue and muscle infection and inflammation: a systemic compartmental approach. Skeletal Radiol 24:317–324 Description and review of multiple soft-tissue infections as diagnosed using computerized tomography.PubMedCrossRefGoogle Scholar
  14. 14.
    Laucks S (1994) Fournier's gangrene. Anorec Surg 74:1339–1352 Review of Fourier's gangrene including anatomical descriptions of perineal fascial planes and description of treatment.Google Scholar
  15. 15.
    Elliott D, Kufera JA, Myers R (1996) Necrotizing soft tissue infections. Ann Surg 224:672–683 Large review of 198 cases of NSTI with extensive analysis and strategies for management.PubMedCrossRefGoogle Scholar
  16. 16.
    Schecter W, Meyer A, Schecter G, Giuliano A, Newmeyer W, Kilgore E (1982) Necrotizing fasciitis of the upper extremity. J Hand Surg 7:15–20 Retrospective review of 33 cases of necrotizing fasciitis of the upper extremity with operative and diagnostic descriptions.Google Scholar
  17. 17.
    Elliott D, Kufera JA, Myers R (2000) The microbiology of necrotizing soft tissue infections. Am J Surg 179:361–366 Large retrospective review of 198 cases of NSTI focusing on bacteriology and antibiotic used in treatment.PubMedCrossRefGoogle Scholar
  18. 18.
    Nolan T, King L, Smith R, Gallup D (1993) Necrotizing surgical infection and necrotizing fasciitis in obstetric and gynecologic patients. South Med J 86:1363–1367 Review and case presentation of necrotizing fasciitis in obstetrical and gynecologic patients with recommendations of early colostomy.PubMedCrossRefGoogle Scholar
  19. 19.
    Brown DR, Davis NL, Lepawsky M, Cunningham J, Kortbeek J (1994) A multicenter review of the treatment of major truncal necrotizing infections with and without hyperbaric oxygen therapy. Am J Surg 167:485–489 Retrospective review of patients with NSTI who received hyperbaric oxygen therapy with those who did not, demonstrating a 12% increase in survival with its use.PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 2003

Authors and Affiliations

  • Seong K. Lee
  • Jan K. Horn

There are no affiliations available

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