Treatment of infected soft tissue loss

Abstract

Hand coverage in infected soft tissue loss (STL) is a challenging clinical condition. Appropriate and well-timed antibiotic therapy and careful debridement are crucial for the success of the subsequent reconstructive procedure. Debridement must be radical, and all nonviable or infected tissue should be removed. Strict medical control and multiple procedures can be required when infection recurrence is observed after primary procedure. Secondary healing of STL is usually necessary in these complex conditions. Negative pressure wound therapy (NPWT) is often used as a temporary instrument to reduce oedema and drainage, facilitating the attainment of a clean wound for subsequent reconstruction. According to the type and size of the defect, multiple options ranging from skin grafts and substitutes to local and free flaps can be selected for the treatment of infected STL. A reconstructive ladder approach and case-by-case decision making should always be considered. Due to the unique function and role of the hand, the surgical strategy must also take into account aesthetic and functional factors. Orthopedic and Plastic surgeons should manage this wide variety of treatment options in a multidisciplinary and high-specialized context including radiologists, microbiologists, infectious disease specialists and physiotherapists, customizing the treatment path to the specific patient's situation.