Senthi Raghavan, R (2011) Necrotizing Soft Tissue Infections Management: A study about the intervention with Long incision fasciiotomies over other Types of traditional management. Masters thesis, Chengalpattu Medical College, Chengalpattu.
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Abstract
INTRODUCTION: Necrotizing Soft Tissue Infections (NSTI’S) comprise a spectrum of disease entities that are characterized by extensive rapidly progressive soft tissue necrosis that usually involves the muscular fascia and subcutaneous tissue, but can also affect skin & muscle. NSTI’S classified as cellulitis, fasciitis or myositis, based on the principle soft tissue layer involved with necrosis. These infections can have either an indolent or fulminant presentation and their clinical course is unpredictable. OBJECTIVE: To study the advantage of decompression by single long incision fasciiotomies with over other types of traditional management in the cases of Necroitizing soft tissue infections. MATERIALS & METHODS: This was a descriptive study conducted at Chengalpattu Medical College, Dept. of General Surgery in unit IV. The wards are 9 & 10, & septic ward over a period of one & half years June 2009 to December 2011. This includes the patients diagnosed as cellulitis, necrotizing fasciitis and admitted through surgical OP & Casualty. The patients below 12 years of age, localized abscesses, intra abdominal solid organs involvement, secondary surgical wound infections and Diabetic foot were excluded from the study. After resuscitation in Casualty reception the patients underwent wound debridement where pus was collected for culture & sensitivity test. Septic OT used in all of the cases. In selected cases single or multiple long incisions done. In few cases all necrosed material and slough was removed. Wound was irrigated with Hydrogen peroxide & Normal saline. The post debridement management included correction of fluid and electrolyte balance coagulation profile, intravenous antibiotics, daily dressings & nutritional supplementation. Antibiotics were changed later according to the culture sensitivity results. The patients were kept in isolated septic ward. Few patients had “Matthan thylam” application which was useful in wound granulation & deodorization. Few of them got opinion from plastic surgery department and received SSG. Later the patients followed up to a possible time intervals. Data was connected with special reference to demographics, clinical features, investigations, co morbidities, involved site, surgical intervention, outcome & follow up. CONCLUSION: The following are conclusions that could be inferred from the study on the surgical spectrum and risk factors among the diseased. - The patients more affected are above 50 yrs (56%). - The male: female ratio is 4:1 - Type of insult. Not known 36%, Snake bite 18%, R T A 10%, Throne prick 5%, Minor abrasions 10%, Others 21%. Parts affected: Lower limb 67%, Scrotum & Low Abdomen 20%, Upper Limb 10%, Trunk with limb 3%, Average time of presentation after symptoms: 7.4 days. Comorbid illnesses: Total number of D M patients 39, Freshly diagnosed D M 8%, Recently diagnosed D M 8%, Known I H D pts 8%, Pts on steroids 3%, Old P T pts 5%, Varicose veins pt 3%, Nil 41%, Known DM II 5%, Others 21%. Blood group affected: A1 +ve 20.5%, A1B +ve 2.5%, AB –ve 2.6%, B +ve 28.2%, O +ve 46.2%. Average time taken for intervention: 6.4 hrs. Type of Intervention: Multiple stab & small incisions 36%, Single or paired long fasciiotomy 51%, incisions with minimal debridment, Vigerous debridment of necrosed tissues 10%, Amputaion (B/K) 3%, Average time taken for recovery (from septicemia& negative culture): Unknown insult cases with long incision fasciiotomies require 3 weeks average. Snake bite cases require average 3.8 weeks. The edema & discharge disappear on 4th to 7th day in unkown insult cases. Snake bite cases also. Multiple stab & small incisions required more than five weeks for –ve Culture & recovery from local symptoms. The edema & discharge persisted more than 25 days in these cases.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Necrotizing Soft Tissue Infections, Management, intervention, Long incision fasciiotomies, traditional management. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Devi S |
| Date Deposited: | 02 Mar 2020 03:37 |
| Last Modified: | 02 Mar 2020 15:25 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/12092 |
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