Extremity Necrotizing Soft Tissue Infections (Visit this link)
Extremity Necrotizing Soft Tissue Infections AAOS Poster Board Number: P422 2005 Theodore Miclau, MD San Francisco CA (n) Christian Ogilvie, MD Merion Station PA (n) -------------------------------------------------------------------------------- This large series without treatment delays shows lower mortality than abdominal infections and demonstrates characteristic findings associated with mortality. Necrotizing soft tissue infections (NSTIs) are potentially fatal infections that often involve the extrmities. The purpose of our study was to determine the mortality rate of extremity NSTIs, and then identify patient characteristics, diagnostic signs, and treatment factors associated with mortality. We performend a retrospective analysisof 150 consecutive cases of extremity NSTIs treated at San Francisco General Hospital. We included cases that involved the extremities, including the hip and shoulder girdles. We recorded information on possible cofactors, treatment, physical findings, radiography, and laboratory findings at presentation. The data was compared statistically between survivors and nonsurvivors. The overall mortality rate was 9.3%. No cofactor predicted increased mortality. Physical exam also revealed common but not predictive findings. Laboratory results indicated that nonsurvivors showed signs of organ dysfunction. Nonsurvivors did not have delays intreatment relative to survivors. Univariate analysis noted increased risk (p<0.05) for mortality with hypotension, hypothermia, low leucocyte count, low bicarbonate levels, elevated BUN, creatinine, AST and potassium levels, and Clostridium species in the wound culture. This is the largest presented series of extremity NSTIs and perhaps the only NSTI study of this size without significant delays in treatment. Extremity NSTIs have a significant mortality rate but less than abdominal NSTIs. Orthopaedic surgeons should become familiar with the manifestations of serious NSTIs and provide timely treatment for such cases.
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Added: Sun Apr 02 2006
