Skin, soft tissue, and hand infection
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Skin, soft tissue, and hand infection
- 1. SKIN, SOFT TISSUE, AND HAND INFECTION FOR INTERNS HAPPY FRIDAY KNIGHT 21ST SEP 2020
- 6. 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
- 7. ABSCESS: A SWOLLEN AREA WITHIN BODY TISSUE, CONTAINING AN ACCUMULATION OF PUS http://www.humanillnesses.com/original/A-As/Abscess.html
- 8. FOLLICULITIS: INFLAMMATION OF THE HAIR FOLLICLES http://www.aocd.org/?page=Folliculitis
- 9. FURUNCLES: INFECTED HAIR FOLLICLES WITH FLUCTUATIONhttp://health-pictures.com/infection/furuncle.htm#.VdTTZvmqqko
- 20. 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
- 21. 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
- 23. DISHWATER PUS Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015. page 153
- 24. 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)
- 25. 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
- 26. NECROTIZING SOFT TISSUE INFECTION: AFTER DEBRIDEMENT Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015. page 153
- 27. OSTEOMYELITIS
- 33. HAND INFECTION • Paronychia • Felon • Pyogenic flexor tenosynovitis • Bursal infection • Web space abscess • Dorsal hand abscess • NF of upper extremities
- 34. 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
- 35. PARONYCHIA • Infection involving tissue surrounding the fingernail • Most organism: S.aureus • Treatment: • Warm soaks • I & D if abscess • Nail plate removal
- 36. FELON • Abscess at pulp of fingertip • Treatment: • Warm soaks • Elevation • Antibiotics • Surgical decompression
- 37. 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
- 39. BURSAL INFECTION • Extending infection of tenosynovitis to Parona’s space • Treatment: • Aggressive debridement under GA
- 40. DEEP SPACE INFECTION • Thenar, hypothenar, and midpalmar space abscess • Web-space abscess (collar-button) • Dorsal hand abscess • Osteomyelitis
- 42. 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