SKIN AND SOFT TISSUE

INFECTION
  Uncomplicated SSTI
Classification of  Nonnecrotizing complicated SSTI
SSTIs  Necrotizing fasciitis
  Uncomplicated SSTIs include superficial cellulitis,
folliculitis, furunculosis, simple abscesses, and minor
wound infections. These infections respond well to
UNCOMPLICATED either source control management (ie, drainage or
SSTI debridement) or a simple course of antibiotics. These
infections pose little risk to life and limb.
  Complicated SSTIs involve the invasion of deeper
tissues and typically require significant surgical
intervention. The response to therapy is often
complicated by underlying disease states. Complicated
COMPLICATED SSTIs include complicated abscesses, infected burn
wounds, infected ulcers, infections in diabetics, and
SSTI deep-space wound infections. They are often limb- or
life-threatening.
 Necrotizing Fasciitis

 Necrotizing fasciitis is a progressive, rapidly spreading,

inflammatory infection that is located in the deep fascia and
is associated with secondary necrosis of the subcutaneous
tissues. The inflammation of the deep fascia causes
thrombosis of the dermal vessels, and it is this thrombosis
that is responsible for the secondary necrosis of the
overlying subcutaneous tissue and skin.
  Systemic signs, in addition to fever, can include
hypotension and tachycardia, which would prompt
closer monitoring and possible hospitalization.
SYMPTOPS
  The physical examination should include descriptions of the
extent and location of erythema, edema, warmth, and tenderness
so that progression or resolution with treatment can be followed
in detail.

 Crepitus can be felt in gas-forming infections and raises the

concern for necrotizing fasciitis and infection with anaerobic
organisms such as Clostridium perfringens.

 Necrosis can occur in brown recluse spider bites, venous snake

bites, or group A streptococcal infections.
PHYSICAL  Fluctuance indicates FLuid and a likely abscess that may need
EXAMINATION incision and drainage.

 Purpura may be present in patients on anticoagulation therapy,

but if it is accompanying an SSTI, it also raises the concern for
the possibility of sepsis and disseminated intravascular
coagulation, especially from streptococcal infections.

 Bullae can be seen in impetigo caused by staphylococci or in

infection with Vibrio vulnicus or Streptococcus pneumoniae.
 We also identified complications, or sequelae, typically
associated with SSTIs. These complications included:
1. Lymphadenitis
2. Myositis/necrotizing fasciitis
3. Gangrene
COMPLICATIONS 4. Osteomyelitis
5. Bacteremia
6. Endocarditis
7. Septicemia, or sepsis