Page 1137 - TNFlipTest
P. 1137
Toronto Notes 2019 Soft Tissue Infections Plastic Surgery PL15 Soft Tissue Infections
Table 13. Classification of Soft Tissue Infections by Depth
Superficial, with upper dermis and superficial lymphatics involvement Full thickness of skin with subcutaneous tissue involvement
Fascia
Muscle
• acuteskininfectionthatismoresuperficialthancellulitis
Etiology
• typicallycausedbyGroupAβ-hemolyticStreptococcus
Clinical Features
• intenseerythema,induration,andsharplydemarcatedborders(differentiatesitfromotherskin infections)
Treatment
• penicillinorfirst-generationcephalosporin(e.g.cefazolinorcephalexin)
Cellulitis
Definition
• non-suppurativeinfectionofskinandsubcutaneoustissues
Etiology
• skinfloraaremostcommonorganisms:S.aureus,β-hemolyticStreptococcus • immunocompromised:Gram-negativerodsandfungi
Clinical Features
• sourceofinfection
■ trauma, recent surgery
■ PVD,DM–crackedskininfeet/toes ■ foreign bodies (IV, orthopedic pins)
• systemicsymptoms(fever,chills,malaise)
• pain,tenderness,edema,erythemawithpoorlydefinedmargins,regionallymphadenopathy • canleadtoascendinglymphangitis(visibleredstreakinginskinproximaltoareaofcellulitis)
Investigations
• CBC,bloodcultures
• cultureandGramstainacollection/aspiratefromwoundifopenwound • plainradiographsshowsofttissueedemaonly
Treatment
• antibiotics:firstline–cephalexin500mgPOq6horcloxacillin500mgPOq6hx7d;ifcomplicated (e.g. lymphangitis, DM, severe infection, oral antibiotic therapy failure), consider IV cefazolin 1-2 g q8h or IV cloxacillin, IV penicillin. All patients should have reassessment in 48 h for resolution if on an oral antibiotic
• outlineareaoferythematomonitorsuccessoftreatment
• immobilizeandsplint(hands)
Necrotizing Fasciitis
Definition
• rapidlyspreading,verypainfulinfectionofthefasciawithnecrosisofsurroundingtissues • somebacteriacreategasthatcanbefeltascrepitusandcanbeseenonx-rays
• infectionspreadsrapidlyalongdeepfascialplaneandislimb-andlife-threatening
Etiology
• TypeI:polymicrobial(lessaggressive)
• TypeII:monomicrobial,usuallyβ-hemolyticStreptococcus
Erysipelas Cellulitis Fasciitis Myositis
Erysipelas
Definition
