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Skin, soft tissue, and hand infection

for interns

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Skin, soft tissue, and hand infection

  1. 1. SKIN, SOFT TISSUE, AND HAND INFECTION FOR INTERNS HAPPY FRIDAY KNIGHT 21ST SEP 2020
  2. 2. SEVERITY • Mild: lesion < 2 cm2, no osteomyelitis, no lymphatic spreading, no sepsis • Moderate: one of >> lesion > 2 cm2, osteomyelitis, lymphatic spreading, sepsis • Severe: criteria moderate + septic shock
  3. 3. ABSCESS: A SWOLLEN AREA WITHIN BODY TISSUE, CONTAINING AN ACCUMULATION OF PUS http://www.humanillnesses.com/original/A-As/Abscess.html
  4. 4. FOLLICULITIS: INFLAMMATION OF THE HAIR FOLLICLES http://www.aocd.org/?page=Folliculitis
  5. 5. FURUNCLES: INFECTED HAIR FOLLICLES WITH FLUCTUATIONhttp://health-pictures.com/infection/furuncle.htm#.VdTTZvmqqko
  6. 6. CARBUNCLE: MULTIPLE FURUNCLES http://byebyedoctor.com/carbuncle/
  7. 7. https://www.pinterest.com/pin/455637687272631453/
  8. 8. ERYSIPELAS http://diseasespictures.com/erysipelas/
  9. 9. CELLULITIS http://billqualls.com/survival/cellulitis/index.html
  10. 10. http://billqualls.com/survival/cellulitis/index.html
  11. 11. http://billqualls.com/survival/cellulitis/index.html
  12. 12. NECROTIZING FASCIITIS http://www.sailinglinks.com/vanuatu.htm
  13. 13. NF AFTER DEBRIDEMENT http://www.sailinglinks.com/vanuatu.htm
  14. 14. WITH VACUUM DRESSING http://www.sailinglinks.com/vanuatu.htm
  15. 15. RESOLVED http://www.sailinglinks.com/vanuatu.htm
  16. 16. NECROTIZING SOFT TISSUE INFECTION (FASCIITIS: NF) • Extremely high mortality rate (80-100%) if delay treatment • 16-24% in rapid recognition • “gas gangrene, rapidly spreading cellulitis, and necrotizing fasciitis” • Risk factors: • elderly • Immunosuppressed including diabetes • Peripheral vascular disease
  17. 17. NECROTIZING SOFT TISSUE INFECTION • Highly suspected in sepsis with minimal wound • History: • within 1 -2 days • Pain out of proportion • Examination: • Greyish, turbid semipurulent material (dishwater pus) • Skin changes: bronze color or brawny induration • Blebs (hemorrhagic) • crepitus
  18. 18. NECROTIZING FASCIITIS
  19. 19. DISHWATER PUS Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015. page 153
  20. 20. NECROTIZING SOFT TISSUE INFECTION • Common organisms: mixed • Streptococcus pyogenes • Pseudomonas aeruginosa • Clostridium perfringens • Investigation: • only lab • imaging is not recommended due to delay intervention (US might be used)
  21. 21. NECROTIZING SOFT TISSUE INFECTION • Treatment: • Emergent aggressive and radical debridement • Direct visualization of potentially infected tissue • Immediate IV antibiotics cover all gram-positive and negative aerobes, and anaerobes • Septic shock resuscitation
  22. 22. NECROTIZING SOFT TISSUE INFECTION: AFTER DEBRIDEMENT Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015. page 153
  23. 23. OSTEOMYELITIS
  24. 24. FOURNIER’S GANGRENE
  25. 25. HAND INFECTION • Paronychia • Felon • Pyogenic flexor tenosynovitis • Bursal infection • Web space abscess • Dorsal hand abscess • NF of upper extremities
  26. 26. MICROBIOLOGY • Staphylococcus aureus • MRSA • Mixed aerobe and anaerobe organisms in immunocompromised host • Human bites: Eikenella corredens • Dog and cat bites: Pasteurella multocida • Maine animal: Vibrio • gas gangrene: Clostidium perfringens, Streptococcus pyogenes, S.aureus, Vibrio vulnificus, polymicrobial
  27. 27. PARONYCHIA • Infection involving tissue surrounding the fingernail • Most organism: S.aureus • Treatment: • Warm soaks • I & D if abscess • Nail plate removal
  28. 28. FELON • Abscess at pulp of fingertip • Treatment: • Warm soaks • Elevation • Antibiotics • Surgical decompression
  29. 29. PYOGENIC FLEXOR TENOSYNOVITIS • Kanavel: cardinal signs: • Tender along sheath • Fixed flex position of finger • Pain on passive extension • Fusiform swelling finger • Treatment: • Conservative if early and healthy patient • Surgery: debridement and flushing tendon sheath
  30. 30. PYOGENIC FLEXOR TENOSYNOVITIS
  31. 31. BURSAL INFECTION • Extending infection of tenosynovitis to Parona’s space • Treatment: • Aggressive debridement under GA
  32. 32. DEEP SPACE INFECTION • Thenar, hypothenar, and midpalmar space abscess • Web-space abscess (collar-button) • Dorsal hand abscess • Osteomyelitis
  33. 33. CONCLUSION… • Skin and soft tissue infection >>> purulent VS non-purulent • Always assess severity • Purulent >> I & D • Non-purulent with septic shock >> always rule out NF

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