Necrotizing soft tissue infections: a surgical narrative review

Area of Science:

• Infectious Diseases
• Surgical Pathology
• Critical Care Medicine

Background:

• Necrotizing soft tissue infections (NSTIs) are severe, rapidly progressive diseases with high mortality.
• NSTIs involve extensive tissue necrosis and can lead to sepsis, septic shock, and multiple organ failure.
• Diagnosis can be delayed due to non-specific clinical presentations.

Purpose of the Study:

• To review the characteristics, predisposing factors, and management of necrotizing soft tissue infections.
• To emphasize the critical role of early diagnosis and surgical intervention in improving patient outcomes.
• To highlight the importance of a multidisciplinary approach in managing NSTIs.

Main Methods:

• Review of existing literature and clinical classifications of NSTIs.
• Analysis of predisposing factors and clinical presentations.
• Discussion of current treatment strategies, including antibiotic therapy and surgical debridement.

Main Results:

• NSTIs are characterized by extensive necrosis of skin, subcutaneous tissues, fascia, or muscles.
• Early recognition and broad-spectrum antibiotics are essential, but surgical debridement is the mainstay of treatment.
• Most patients require multiple surgical debridements and may need transfer to a specialized center.

Conclusions:

• Rapid recognition and aggressive surgical management, including repeated debridements, are critical for NSTI treatment.
• Antibiotic therapy should be guided by identified pathogens after initial broad-spectrum coverage.
• A multidisciplinary team approach is vital for optimizing outcomes in patients with necrotizing soft tissue infections.