Necrotizing Soft Tissue Infections of the Upper Extremity

Melillo, Atlee; Addagatla, Kamal; Jarrett, Nicole J.

doi:10.1016/j.hcl.2020.03.007

Cited by 7 publications

(14 citation statements)

References 26 publications

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“…Type I is the most common, accounting for 80% of the cases, followed by type II, which accounts for 10%-15% of cases. 5 With type II encompassing up to 15% of cases, empiric antibiotic coverage for these bacteria should be included in the treatment regimen. Particularly, GAS has been demonstrated to be associated with higher amputation rates.…”

Section: Discussionmentioning

confidence: 99%

Use of Clindamycin for Necrotizing Soft Tissue Infection Decreases Amputation Rate

Heath

Boyer

Ghali

et al. 2022

Journal of Orthopaedic Trauma

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Objective:To identify the impact of clindamycin use on mortality and amputation rates in patients with necrotizing fasciitis.Design:Retrospective review.Setting:Level 1 trauma center, single-center study.Patients/Participants:All patients from 2008 to 2019 with a diagnosis of necrotizing fasciitis. One hundred ninety patients were included in statistical analysis.Intervention:Use of clindamycin in the initial antibiotic regimen in the treatment of necrotizing soft tissue infection.Main Outcome Measurements:Amputation and mortality rates.Results:Patients who received clindamycin had 2.92 times reduced odds of having an amputation when compared with their counterparts, even when American Society of Anesthesiologist scores, comorbidities, smoking, drug use, alcohol consumption, race, ethnicity, sex, and age were controlled for and regardless of other antibiotics started (P = 0.015). There was no significant difference in mortality rate between those patients who did and did not receive clindamycin as part of their initial antibiotic regimen (8.3% vs. 11.6%, respectively; P = 0.453).Conclusion:The use of clindamycin in the initial antibiotic regimen for treatment of NSTI was shown to significantly decrease rates of amputation but not mortality.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Use of Clindamycin for Necrotizing Soft Tissue Infection Decreases Amputation Rate

Heath

Boyer

Ghali

et al. 2022

Journal of Orthopaedic Trauma

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“…4 From the reviewed literature, 35 articles provide information about patients' gender and age. 5,6,8,10,[13][14][15][16][17][18] On a total of 379 patients with NF of the upper extremity, 257 were male (67,8%) and 122 were female (32,2%). The average age of these patients was 56,4 and ranged between 20 and 86 years old (underage patients were excluded from the data selection).…”

Section: Infectionmentioning

confidence: 99%

“…However, approximately 11%-20% of cases are idiopathic. 7,8 NF demonstrates a wide variety of causative microorganisms, depending on geographical region and demographics. Mixed flora cases predominate over single organism infections and the most recurrent pathogens are gram-positive organisms (usually Streptococcus and Staphylococcus species).…”

Section: Introductionmentioning

confidence: 99%

Necrotizing Fasciitis of the Upper Extremity – A Review

Δίτσιος

Chitas

Christidis³

et al. 2022

Orthopedic Reviews

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Necrotizing fasciitis is a soft tissue infection that habitually originates from the fascial sheaths, expands at a volant pace, leads to extensive necrosis of the subcutaneous tissues, and eventually ends up in a life-threatening condition with notably elevated amputation and mortality rates. Factors that induce interruption of skin integrity, such as trauma or intravenous drug use, are the most common inciting events. Specific clinical signs heralding its presence are usually absent in the early stages, often resulting in misdiagnosis. Early recognition, prompt and aggressive surgical debridement, antibiotic use, and supportive care constitute the fundamental principles to lean on for a better prognosis. Necrotizing fasciitis of the upper extremity is relatively rare and consequently holds a limited place in the literature. Only a few studies assess it as a separate entity, with most of them being case reports or small case series. We, therefore, performed a review of the current literature, to assemble the dispersed results of different studies and clarify the various aspects of upper limb necrotizing fasciitis. In this systematic review, we present the epidemiological data, the causative events, the most frequent underlying diseases, the risk factors, the amputation and mortality rates, the pathogenic microorganisms, the clinical characteristics, the diagnostic tools, the medical and surgical management concerning necrotizing fasciitis of the upper limb. Finally, the results indicating its differentiation compared to necrotizing fasciitis of other anatomic sites are remarkably highlighted.

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“…Дистантные лоскуты, такие как стебельчатый паховый или лоскут передней брюшной стенки, считаются надежными, особенно у пациентов в тяжелом состоянии или с сопутствующими сосудистыми поражениями (обширные ожоги, сахарный диабет), для которых длительные микрохирургические пересадки имеют серьезные противопоказания [27][28][29][30]. Выполнение операций по их перемещению технически проще и быстрее, требуют меньшей предоперационной подготовки пациента и послеоперационного мониторинга в сравнении со свободными лоскутами [31].…”

Section: Introductionunclassified

“…Относительно узкое основание лоскута позволяет моделировать его без складок и неровностей в реципиентной зоне. Основными их недостатками являются: этапность, необходимость иммобилизации в вынужденном положении конечности и связанная с этим потенциальная необходимость разработки движений, что трудно осуществимо у детей раннего возраста, а также последующие редукцион-ные оперативные вмешательства, направленные на уменьшение избыточного объема подкожного жира в зоне перемещенного лоскута [32].…”

Section: Introductionunclassified

Local, regional and distant flaps in reconstructive hand surgery in children

et al. 2022

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Objective. Hand injuries in children are quite common. Most challenging within plastic and reconstructive surgery/reconstructive microsurgery expertise were there traumatic hand defect and upper extremities open injuries sequels. There were wide variety of reconstruction techniques to deal with hand defects in general and with distal phalanx defects particularly. The core problem is how to make very choice of reconstructive method and technique from diversity of local, regional and distant flaps. Injuries of distal phalanges are the most common type of hand trauma in children. The problem of coverage of soft tissue defects of distal phalanges remains actual. A lot of methods of coverage of distal phalanges defects are developed. There is no generally accepted approach or an algorithm in the treatment of adults and children with such type of trauma.Material and methods. In the period from 2018 to 2021 at the Microsurgery Department of N.F. Filatov Moscow Clinical Hospital for Children 152 surgical operations using local (68), regional (72) and distant (12) flaps were performed.Results. All flaps in all patients within our clinical series have survived. There were neither major complication no secondary revisional procedures. Used different flaps in general provided transport of adequate viable donor tissues to recipient areas of critical functional significance. The selection of particular flap we have been making on individual basis mostly depending on type and injury severity, and functional requirement and prognosis.Conclusion. We are considering surgeon’s own experience is main defining factor to make selection of certain method from the diversity of different flaps.

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Necrotizing Soft Tissue Infections of the Upper Extremity

Cited by 7 publications

References 26 publications

Use of Clindamycin for Necrotizing Soft Tissue Infection Decreases Amputation Rate

Use of Clindamycin for Necrotizing Soft Tissue Infection Decreases Amputation Rate

Necrotizing Fasciitis of the Upper Extremity – A Review

Local, regional and distant flaps in reconstructive hand surgery in children

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