NECROTISING FASCIITIS

• It is Spreading , destructive ,invasive

infection of skin and soft tissue include
deep fascia, but spare muscles .
• Common site: lower extremities,
genitals, lower abdomen.
• Also called meleneys gangrene.
TYPES;-

1. Type 1:- polymicrobial,very often there is no history of injury

2. Type 2:- monomicrobial, flesh eating disease.
3. Type 3:- gas gangrene.
4. Type 4:- fungal and vibrio species.
CLINICAL :-

1. Sudden pain with gross swelling of the limbs .

2. Part red , oedematous with skin necrosis and ulceration.
3. Thrombosis of nutrient artery
4. High grade fever , jaundice, renal failure
DIAGNOSIS AND TREATMENT:-

1. White cell count, C-reactive protein, heamoglobin, creatinine, glucose,

biopsy, finger test
• Treament:-
1. Supportive treatment include hospitalisation , hydration, hypotension
treatment, broad spectrum antibiotics.
2. Intravenous immunoglobulin.
ACUTE PYOMYOSITIS:-

• Localised area of suppuration within striated muscle.

• Occurs after trauma
• Clinical features:- quadriceps, gluteus, shoulder muscles are
affected
• Pain , oedema,fever and jaundice, tenderness,induration,and
muscle spasms , renal failure follow soon .
INVESTIGATION AND TREATMENT:-

• Sonographic guided aspiration of pus

• CT and MRI
• Creatine kinase (50,000-2,00,000 units /L)
• Treatment:- antibiotics
• Wide excision of muscles and compartmental excision .
SURGICAL SITE INFECTION:-

• Refers to infection of the tissue,organ or space that exposed during

invasive surgical procedure.
• Superficial, redness of postoperative wound or swollen local part ,
• Associated with systemic inflammatory response syndrome, it is called
sepsis , associated with organ failure and requires inotropes called severe
sepsis.
CLASSIFICATION:-

• Predisposition:-advancing age , immunosuppression

that affect survival.
• Insult :- depends on infecting organism,
• Response:- development of shock, elevated c-
reactive protein
• Organ dysfunction:- failure or dysfunction of organ
CLINICAL FEATURES:-

• Superficial SSI:- wound is tender, erythematous, oedematous.

• Deep incisional SSI:- tenderness extends crepitus, vesicles and
bullae
• Intra cavitary SSI : involved on system involved.
PREVENTING SOURCES OF SSIS

1. Standardised antibiotics prophylaxis.

2. Skin is prepared by iodophors
3. Sterile dressing
4. Safe operating room
5. Showers and decolonization
6. Screening for colonization
 ASEPSIS AND ANTISEPSIS
ASEPSIS
• Refers to precautions taken
before any surgical procedure to
prevent against the development
of infection .
• Eg wearing gloves, cleaning patient
abdomen with iodine
ANTISEPSIS
• Practice of using antiseptic to
eliminate disease causing
microorganism
• Eg dressing vm of already contaminated
wound using carbolic acid
• Broad spectrum antibiotics