Abstract:
: Background: A skin-sparing approach for the treatment of necrotizing soft-tissue infections (NSTIs) removes necrotic tissue planes while leaving viable overlying skin. Subsequent closure of the spared skin may decrease the need for graft-based reconstruction, which is associated with contracture, pain, and deformity. This study compared the outcomes of a traditional approach (excision of overlying skin with diseased fascia) with that of a skin-sparing approach for patients with NSTI treated at a major metropolitan medical center. Methods: Demographic, clinical, and operative details for patients treated for NSTI between July 2012 and December 2016 at a single institution were reviewed retrospectively. Pre-operative and post-operative photographs were evaluated independently by three surgeons to determine reconstructive outcomes. Cohen's κ was used to assess inter-rater reliability. Multiple regression and Poisson regression models were used to assess the association between outcomes and the surgical approach. Results: A total of 487 patients were divided into two cohorts: Traditional approach (TA), treated between July 2012 and December 2014 (n = 230), and skin-sparing approach (SS), treated after January 2015 (n = 257). The mortality rate in the two groups was equal at approximately 10%. The median percentage of each wound closed by skin graft was significantly lower for the SS group than for the TA group (20% versus 90%; p < 0.0001) with a correspondingly higher median percentage of primary skin closure for the SS group (50% versus 0; p < 0.0001). Conclusions: Relative to traditional debridement, skin-sparing debridement for source control of NSTI results in significantly more wounds closed completely by delayed primary suture of existing skin flaps and a significantly lower overall wound percentage closed by skin graft, while demonstrating equivalent efficacy of source control and a similar low mortality rate.
journal_name
Surg Infect (Larchmt)journal_title
Surgical infectionsauthors
Tom LK,Maine RG,Wang CS,Parent BA,Bulger EM,Keys KAdoi
10.1089/sur.2019.263subject
Has Abstractpub_date
2020-05-01 00:00:00pages
363-369issue
4eissn
1096-2964issn
1557-8674journal_volume
21pub_type
杂志文章abstract:BACKGROUND AND PURPOSE:Each year, as many as two million operations are complicated by surgical site infections in the United States, and surgical patients account for 30% of patients with sepsis. The purpose of this study was to determine recent trends in sepsis incidence, severity, and mortality rate after surgical p...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2008.046
更新日期:2009-02-01 00:00:00
abstract:BACKGROUND:Staphylococcus aureus nasal carriage is an independent risk factor for developing nosocomial infections and for developing surgical site infection (SSI) in particular. The number of post-operative nosocomial S. aureus infections can be reduced by screening patients and decolonizing nasal carriers. In additio...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2014.022
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abstract:BACKGROUND:Tracheostomy is one of the most common procedures performed in trauma patients in the intensive care unit (ICU). Few studies have evaluated the incidence of surgical site infections (SSIs) specifically in a trauma population. Our objective was to compare the incidence of SSI after open versus percutaneous tr...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2011.059
更新日期:2013-02-01 00:00:00
abstract:BACKGROUND:Fungal sinusitis has been reported increasingly in immunocompetent patients. However, the most effective, appropriate mode of therapy has not been determined. MATERIALS AND METHODS:In this retrospective study, we examined the records of 110 immunocompetent patients with chronic sinusitis who had undergone s...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/109629603766956997
更新日期:2003-07-01 00:00:00
abstract:: Background: Surgical site infections (SSIs) are recognized complications of surgical procedures. Methicillin-resistant Staphylococcus aureus (MRSA) colonization increases the likelihood of developing SSIs. Decolonization of MRSA has been shown to reduce post-operative SSIs...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2020.020
更新日期:2020-05-04 00:00:00
abstract:: Background: Biliary tract infection (BTI) is a common complication in patients with biliary obstruction caused by various biliary tract disorders. To improve the management of patients with BTI, microbial profiles from bile cultures and antibiotic resistance patterns were ...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2019.041
更新日期:2019-09-01 00:00:00
abstract:BACKGROUND:We identified recently esophageal cancer related gene-4 (ECRG4) as a candidate cytokine that is expressed on the surface of quiescent polymorphonuclear leukocytes (PMNs) and shed in response to ex vivo treatment with lipopolysaccharide. To investigate the potential biologic relevance of changes in cell surfa...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2014.209
更新日期:2015-12-01 00:00:00
abstract:BACKGROUND:Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection affecting as many as 27% of mechanically ventilated patients. Ventilator-associated pneumonia is an important source of morbidity and mortality in the surgical intensive care unit (SICU). The optimal diagnostic method for VAP h...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2013.142
更新日期:2014-10-01 00:00:00
abstract::Complicated intra-abdominal infections (cIAIs) are still associated with high morbidity and mortality levels. Early prognostic evaluation is a great challenge, and a serious amount of resources have been used to find the perfect mortality predictor. Monocyte human leukocyte antigen-DR (mHLA-DR) expression has been stu...
journal_title:Surgical infections
pub_type: 杂志文章,评审
doi:10.1089/sur.2019.050
更新日期:2020-03-01 00:00:00
abstract:BACKGROUND:Bacterial infections are a well-known complication of traumatic amputations. In cases involving contact with soil or water contaminated with manure, one also must be aware of infections with fungi, particularly Scedosporium spp. We report on an immunocompetent trauma patient with an infection caused by a rec...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2006.038
更新日期:2007-12-01 00:00:00
abstract:BACKGROUND AND PURPOSE:The exact mechanism of fever and urosepsis after percutaneous procedures has not been established. This research studied the frequency of fever after percutaneous nephrolithotomy (PCNL) and the contributing factors. METHODS:In a cross-sectional study, from September 2003 to March 2004, all 217 p...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2006.7.367
更新日期:2006-08-01 00:00:00
abstract:: Background: Hand infections can spread quickly and destroy functional structures. Early diagnosis and adequate therapy can prevent severe morbidities. The aim of this study was to evaluate systematically the spread of hand infections according to injury mechanism, pathogen...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2020.035
更新日期:2020-07-28 00:00:00
abstract:BACKGROUND:The Donor Risk Index (DRI) is used to predict graft survival following liver transplantation, but has not been used to predict post-operative infections in graft recipients. We hypothesized that lower-quality grafts would result in more frequent infectious complications. METHODS:Using a prospectively collec...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2013.035
更新日期:2014-04-01 00:00:00
abstract:BACKGROUND:Nutritional status has major impacts on the outcome of surgery, in particular in patients with cancer. The aim of this review was to assess the merit of oral pre-operative nutritional support as a part of prehabilitation in patients undergoing surgery for colorectal cancer. METHODS:A systematic literature s...
journal_title:Surgical infections
pub_type: 杂志文章,meta分析,评审
doi:10.1089/sur.2017.143
更新日期:2018-01-01 00:00:00
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journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2012.227
更新日期:2014-02-01 00:00:00
abstract:BACKGROUND:Pre-existing humoral barriers challenge the transplantation of living donor kidneys (LDK) into highly sensitized ABO- and human leukocyte antigen (HLA)-incompatible recipients. Conditioning these LDK recipients' immune systems is required before they undergo transplantation. We hypothesized that medical dese...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2012.231
更新日期:2014-06-01 00:00:00
abstract:BACKGROUND:Most HIV-1 replication occurs in secondary lymphoid tissues, and evaluating these tissues is crucial to investigations of pathogenesis. Inguinal lymph nodes (LN) are obtained frequently for these studies as they are readily detectable in most individuals and provide abundant numbers of cells. Knowledge of th...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2013.218
更新日期:2014-08-01 00:00:00
abstract:BACKGROUND:Group A streptococcal necrotizing soft-tissue infection with toxic shock is a life-threatening disease. Corticosteroid use in the treatment of this process has been reported rarely. METHOD:Case reports and review of pertinent literature. RESULTS:Two infections caused by the same clonal strain of Streptococ...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2010.035
更新日期:2011-02-01 00:00:00
abstract:BACKGROUND:Low plasma concentrations and genetic polymorphisms of mannan-binding lectin (MBL) have been associated with infectious disease complications during various conditions. The present study examined the nature and expression of MBL deficiency during a surgery-induced acute-phase response. METHODS:Blood was sam...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2006.7.443
更新日期:2006-10-01 00:00:00
abstract:BACKGROUND:The Surviving Sepsis Campaign (SSC) was launched in 2002 as a collaborative initiative of the European Society of Intensive Care Medicine (ESICM), the International Sepsis Forum (ISF), and the Society of Critical Care Medicine (SCCM). Its objective was, through the development and promulgation of evidence-ba...
journal_title:Surgical infections
pub_type: 杂志文章,评审
doi:10.1089/sur.2010.024
更新日期:2010-06-01 00:00:00
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journal_title:Surgical infections
pub_type: 杂志文章,多中心研究
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更新日期:2016-08-01 00:00:00
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journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2019.135
更新日期:2019-10-01 00:00:00
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journal_title:Surgical infections
pub_type: 杂志文章,评审
doi:10.1089/sur.2007.079
更新日期:2008-08-01 00:00:00
abstract:BACKGROUND:Surgical site infections are reduced by appropriate and timely antimicrobial prophylaxis. Consensus guidelines recommend that antimicrobial infusion begin within 60 min prior to creation of the incision. An internal audit of our institution suggested poor guideline compliance. We hypothesized that the additi...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2008.054
更新日期:2010-08-01 00:00:00
abstract:BACKGROUND:Vancomycin is used widely as empiric therapy for gram-positive organisms in patients with an intra-abdominal infection (IAI), even in those with no history of methicillin-resistant Staphylococcus aureus (MRSA) infection or colonization. Potential adverse effects of vancomycin include nephrotoxicity, increase...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2014.211
更新日期:2015-08-01 00:00:00
abstract:BACKGROUND:Vancomycin is the mainstay of treatment for methicillin-resistant Staphylococcus aureus (MRSA) meningitis. However, successful outcomes with linezolid have not been reported in a large series of patients. We conducted a single-center retrospective cohort study to compare vancomycin with linezolid in the trea...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2012.091
更新日期:2013-08-01 00:00:00
abstract:BACKGROUND:Solid organ transplantation (SOT) frequently is complicated by cytomegalovirus (CMV) infections. Cidofovir (CDV) is active against CMV, including many ganciclovir (GCV)-resistant mutants, but often is considered to be too nephrotoxic for use after organ transplantation. PATIENTS AND METHODS:Seven males and ...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2015.266
更新日期:2017-02-01 00:00:00
abstract:: Background: The greatest burden of sepsis- and septic shock-related morbidity and mortality is in low- and middle-income countries (LMICs). Accurate tracking of incidence and outcomes of patients in LMICs with sepsis has been limited by changing definitions, lack of diagno...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2020.047
更新日期:2020-09-01 00:00:00
abstract:BACKGROUND:Group A Streptococcus (GAS) is an uncommon cause of infection after clean surgery in non-pregnant adults. METHODS:Report of three cases and review of the literature. results: For the first time in France, severe GAS infections were observed in three patients who underwent thyroidectomy at three hospitals. T...
journal_title:Surgical infections
pub_type: 杂志文章,评审
doi:10.1089/sur.2007.069
更新日期:2008-10-01 00:00:00
abstract:: Background: Operating room (OR) traffic and door openings have emerged as potential modifiable risk factors for the development of surgical site infections. Methods: This study compared the microbial load of a Control OR withou...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2020.361
更新日期:2020-12-23 00:00:00