Review
Classic diseases revisited
Necrotizing soft tissue
infections
John D Urschel
Department of
Surgery, McMaster University, Hamilton, Ontario, Canada
Correspondence to: John Urschel, MD, Chief of Surgery, St Joseph's Hospital, 50 Charlton Avenue East, Hamilton, Ontario, Canada L8N 4A6
Accepted 3 June 1999
Necrotizing soft tissue infections are a group of highly lethal
infections that typically occur after trauma or surgery. Many individual infectious entities have been described, but they all have
similar pathophysiologies, clinical features, and treatment approaches.
The essentials of successful treatment include early diagnosis,
aggressive surgical debridement, antibiotics, and supportive intensive
treatment unit care. The two commonest pitfalls in management are
failure of early diagnosis and inadequate surgical debridement. These
life-threatening infections are often mistaken for cellulitis or
innocent wound infections, and this is responsible for diagnostic delay. Tissue gas is not a universal finding in necrotizing soft tissue
infections. This misconception also contributes to diagnostic errors.
Incision and drainage is an inappropriate surgical strategy for
necrotizing soft tissue infections; excisional debridement is needed.
Hyperbaric oxygen therapy may be useful, but it is not as important as
aggressive surgical therapy. Despite advances in antibiotic therapy and
intensive treatment unit medicine, the mortality of necrotizing soft
tissue infections is still high. This article emphasizes common
treatment principles for all of these infections, and reviews some of
the more important individual necrotizing soft tissue infectious entities.
Keywords: fasciitis; gas gangrene; clostridium infections; streptococcal infections; necrosis; debridement; surgical infections; soft tissue infections
© 1999 by The Fellowship of Postgraduate Medicine
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