ABSTRACT
Necrotizing soft tissue infections are caused by a variety of pathogens and may affect different types of soft tissue. Even today mortality and lethality are very high. The primary symptoms of necrotizing soft tissue infections are local pain out of proportion, swelling, erythema and crepitation in cases of subcutaneous gas. A systemic inflammatory response syndrome (SIRS) is often associated. During the last decades early recognition and initiation of an adequate therapy were able to reduce lethality to an average of 20%. The physical examination remains the diagnostic gold standard and may be supported by typical findings of imaging technologies, e.g. subcutaneous gas on x-rays and laboratory tests. After diagnosis an adequate antibiotic and surgical therapy should be performed immediately.
Subject(s)
Skin Diseases, Bacterial/classification , Skin Diseases, Bacterial/diagnosis , Soft Tissue Infections/classification , Soft Tissue Infections/diagnosis , Anti-Bacterial Agents/therapeutic use , Combined Modality Therapy , Connective Tissue/pathology , Connective Tissue/surgery , Debridement , Diagnosis, Differential , Fasciitis, Necrotizing/classification , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/pathology , Fasciitis, Necrotizing/surgery , Fournier Gangrene/classification , Fournier Gangrene/diagnosis , Fournier Gangrene/pathology , Fournier Gangrene/surgery , Gas Gangrene/classification , Gas Gangrene/diagnosis , Gas Gangrene/pathology , Gas Gangrene/surgery , Humans , Necrosis , Skin/pathology , Skin Diseases, Bacterial/pathology , Skin Diseases, Bacterial/surgery , Soft Tissue Infections/pathology , Soft Tissue Infections/surgery , Systemic Inflammatory Response Syndrome/classification , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/pathology , Systemic Inflammatory Response Syndrome/therapySubject(s)
Bacteria, Anaerobic , Bacterial Infections/diagnosis , Bacterial Infections/classification , Bacterial Infections/microbiology , Bacterial Infections/therapy , Clostridium Infections/classification , Clostridium Infections/diagnosis , Clostridium Infections/microbiology , Clostridium Infections/therapy , Diagnosis, Differential , Gas Gangrene/classification , Gas Gangrene/diagnosis , Gas Gangrene/microbiology , Gas Gangrene/therapy , HumansABSTRACT
The clinical histories of 28 cases registered as gas gangrene by the Swiss National Accident Insurance (Schweizerische Unfallversicherungsanstalt) from 1963 to 1975 are reviewed. According to the classification of Altemeier (1. gas gangrene, 2. clostridial cellulitis, 3. simple contamination of a wound by Clostridium, and 4. gaseous infection without Clostridium) only 5 cases were assignable to group one (1 survivor), 2 cases to group two, 9 to group three and 9 to group four. Typical cases from each group are discussed to illustrate the advantages of this classification, the dangers of treatment based on wrong diagnosis, and the necessary prophylaxis. The more serious prognosis in gas gangrene in comparison to the other groups is emphasized.
