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Severe Necrotizing Soft-Tissue Infections Multiple Disease Entities Requiring a Common Approach

E. Patchen Dellinger, MD
JAMA. 1981;246(15):1717-1721. doi:10.1001/jama.1981.03320150059037.
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The spectrum of severe soft-tissue surgical infections extends from synergistic necrotizing soft-tissue infections to histotoxic clostridial infections. These syndromes may demonstrate dramatic destruction of underlying tissue far out of proportion to the external evidence for infection, although a marked systemic response is common. The differential diagnosis hinges on the clinical presentation, the Gram's stain, and operative inspection. More important than the precise label placed on a given case is the early recognition of the urgent surgical nature of the infection. Signs indicating a rapidly spreading soft-tissue infection mandate fluid resuscitation, broad-spectrum antibiotics, and early operative exploration with aggressive debridement. These are highly lethal infections in which timely recognition and effective managment may be lifesaving.

(JAMA 1981;246:1717-1721)


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