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Synergistic soft tissue infections of the perineum
1George Washington University Hospital, Department of Surgery, Washington, D.C.
Abstract:
Seven patients with necrotizing soft tissue infections of the perineum are described. Predisposing factors related to infection were present in four patients (diabetes mellitus, multiple myeloma, HIV, and a poorly defined immunodeficiency syndrome). Anaerobic and facultative anaerobic bacteria were cultured in each case. Two patients required skin graft closure of the debrided wounds, with the remaining wounds closed by contracture and epithelialization. A diverting sigmoid colostomy to facilitate wound care was performed on one patient who had complete dissolution of all anal sphincters. The role of hyperbaric oxygen therapy in four patients was of uncertain value.
Insights
Necrotizing soft tissue infections of the perineum are serious, often involving anaerobic bacteria. Treatment varied, with surgical debridement and wound closure methods including skin grafts and natural healing.
Area of Science:
- Infectious Diseases
- Surgical Pathology
- Microbiology
Background:
- Necrotizing soft tissue infections (NSTIs) of the perineum are severe conditions.
- These infections can be polymicrobial, involving anaerobic and facultative anaerobic bacteria.
- Predisposing factors include diabetes mellitus, multiple myeloma, HIV, and immunodeficiency.
Purpose of the Study:
- To describe the clinical presentation and management of seven patients with perineal necrotizing soft tissue infections.
- To evaluate the outcomes of different surgical interventions and adjunctive therapies.
Main Methods:
- Retrospective case series of seven patients with perineal necrotizing soft tissue infections.
- Cultures for bacterial identification.
- Surgical debridement and wound closure techniques.
- Assessment of adjunctive therapies, including hyperbaric oxygen therapy.
Main Results:
- All seven patients had polymicrobial infections with anaerobic and facultative anaerobic bacteria.
- Two patients required skin grafts for wound closure.
- Five patients achieved wound closure through contracture and epithelialization.
- One patient underwent sigmoid colostomy due to anal sphincter dissolution.
- The benefit of hyperbaric oxygen therapy was uncertain in four treated patients.
Conclusions:
- Perineal necrotizing soft tissue infections require aggressive surgical management.
- Wound closure strategies vary based on defect size and patient factors.
- The role of hyperbaric oxygen therapy in these infections warrants further investigation.