The importance of source control in the management of severe skin and soft tissue infections.

Abstract

Recent studies mainly deal with the relevance of antibiotics in the treatment of complicated skin and soft tissue infections (cSSTIs) with or without sepsis. The impact of surgical source control for severely ill patients with sepsis is underrepresented in the literature. This review tries to add new information on this topic. Source control in cSSTI ranges from removal of central venous catheters to radical debridement of extensive body areas. Necrotizing soft tissue infections serve as a model disease for the value of surgical measures in severe cSSTI. Early diagnosis and timing of surgical intervention, the necessary extent of surgery and the assessment of adjunctive therapies (hyperbaric oxygenation, intravenous immunoglobulins) have been recently investigated. The evidence for simple source control measures (i.e., opening and drainage of an abscess) remains low, but appears to be self-evident. Radical debridement remains the standard of care for those patients with soft tissue sepsis because of necrotizing soft tissue infections. Surgical treatment should be performed latest within 12 h after admission. The value of other adjunctive measures (hyperbaric oxygen therapy, intravenous immunoglobulins) is uncertain. Only an aggressive approach offers the possibility to save life and limbs of the affected patients.