Soft Tissue Infection

Abstract

Soft tissue infections are a diverse group of diseases that involve the skin and underlying subcutaneous tissue, fascia, or muscle. The authors review the diagnosis and management of the main soft tissue infections seen by surgeons, including both superficial infections and necrotizing infections. When the characteristic clinical features of necrotizing soft tissue infection are absent, diagnosis may be difficult. In this setting, laboratory and imaging studies become important. Studies emphasizes that computed tomography should continue to be used judiciously as an adjunct to clinical judgment. The delay between hospital admission and initial débridement is the most critical factor influencing morbidity and mortality. Once the diagnosis of necrotizing soft tissue infection is established, patient survival and soft tissue preservation are best achieved by means of prompt operation. Bacterial infections of the dermis and epidermis are covered in depth, along with animal and human bites. Methicillin-resistant Staphylococcus aureus (MRSA) accounts for up to 70% of all S. aureus infections acquired in the community and is the most common organism identified in patients presenting to the emergency department with a skin or soft tissue infection. The more classic findings associated with deep necrotizing infections—skin discoloration, the formation of bullae, and intense erythema—occur much later in the process. It is important to understand this point so that an early diagnosis can be made and appropriate treatment promptly instituted. The review’s discussion covers in depth the etiology and classification of soft tissue infection, pathogenesis of soft tissue infections, toxic shock syndrome, and reports on mortality from necrotizing soft tissue infection. This review 8 figures, 22 tables, and 58 references. Keywords: Erysipelas, cellulitis, soft tissue infection, necrotizing fasciitis, myonecrosis, toxic shock syndrome