Necrotizing Soft-tissue Infections: An Orthopaedic Emergency
Adam Lee1, Addison May, William T Obremskey
1From the Department of Orthopaedic Surgery (Dr. Lee), Keck Medical Center of USC, Los Angeles, CA, the Surgical Critical Care (Dr. May), Surgical Critical Care and Acute Care Surgery Fellowship (Dr. May), Surgery and Anesthesiology (Dr. May), Surgical Science (Dr. May), Vanderbilt University Medical Center, Nashville, TN, and the Orthopedic Surgery (Dr. Obremskey), Vanderbilt Medical Center, Nashville, TN.
The Journal of the American Academy of Orthopaedic Surgeons
|November 16, 2018
Summary
Necrotizing soft-tissue infections (NSTIs) are aggressive bacterial infections requiring urgent surgical intervention. Prompt recognition and extensive debridement are crucial to prevent limb loss and mortality.
Area of Science:
- Infectious Diseases
- Orthopaedic Surgery
- Emergency Medicine
Background:
- Necrotizing soft-tissue infections (NSTIs) are severe bacterial infections affecting all patient populations.
- Initial symptoms like erythema and edema can be nonspecific, delaying diagnosis.
Purpose of the Study:
- To highlight the critical need for early identification and management of NSTIs.
- To emphasize the importance of prompt surgical intervention in NSTI cases.
Main Methods:
- Review of clinical presentation and diagnostic indicators of NSTIs.
- Emphasis on the cornerstone of management: extensive surgical debridement and broad-spectrum antibiotics.
Main Results:
- NSTIs progress rapidly, with classic signs including bullae, anesthesia, ecchymosis, tense edema, and gas.
- Pain disproportionate to clinical findings and rapid progression despite antibiotics are key indicators.
Conclusions:
- High clinical suspicion is essential for timely diagnosis and treatment of NSTIs.
- Early surgical debridement is paramount and should precede patient transfer due to high risks of morbidity and mortality associated with delay.
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