1.4. Soft tissue infections (phlehmone, abscess, gangrena), NPWT (wound treatment, open abdomen treatment)

What are soft tissue infections

Microbial infections that affect the skin, subcutaneous tissue, muscle and fascia

What is the differential diagnosis

Differentiate from other skin or soft tissue conditions

• cellulitis

• erysipelas

• necrotising fascitis

What are the types of soft tissue I

• phlegmon

• abscess

• gangrene

What is phlegmon

Diffuse inflammation without localised pus formation

What are the causes of phlegmon

• streptococci

• mixed flora

What are the clinical features of phlegmon

• erythema

• swelling

• not well defined borders

What is the treatment of phlegmon

• antibiotics covering strep + anaerobes

• surgical intervention is RARELY needed

What are abscesses

Collection of pus surrounded by inflammed tissue

What is the cause of abscesses

• Staph aureus

• anaerobic bacteria

What are the clinical features of abscesses

• well circimscribed, fluctuant swelling

• localised pain and tenderness

What is the treatment of abscesses

• incision and drainage

• empiric antibiotics

What is gangrene

Necrosis of tissue due to lack of blood supply

What are the causes of gangrene

• ischemia dry/ iscehma + infection= wet

• Dry- coagulative necrosis

• wet- liquefactive necrosis

What are the treatments of gangrene

• urgent surgical intervention to restore blood supply

• amputation if tissue is unsalvageable

• broad spectrum antibiotics for secondary ifnections

What is NPWT

Wound dressing systems that continuously or intermittently apply subatmospheric pressure to surface of wound to help healing

also called Vacuum Assisted wound Closure- VAC

What is the mechanism of action of NPWT

1. one irection flow

2. decreasing oedema

3. increasing blood supply

4. remove wound exudate- cytokines inhibit wound healing

5. reduction of colonisation

What is the indication of NPWT

• wounds that don’t heal with traditional treatment

• applied in sterile circumstances

What are the contrainidactions of NPWT

• fluid collection, which has not been drained or in case of fistula

• necrotic wound base, osteomyelitis, malignant wounds

What are the advantages of NPWT

• fewer wound dressings needed

• faster wound healing

• can inhibit further complications

What are the disadvantages of NPWT

• expensive

• delayed application can cause unsuccesful outcome

• learning curve is big

• thorough debridement cannot be avoided

What is the goal of treatment of open abdomen with NPWT

• decrease pressure

• decrease development of sepsis

• closure of abdominal wall

• protective layer of organs

• cover the entire abdominal cavity

• smallest necessary foam should be applied

What are the indications of NPWT in open abdomen

• Damage-control laparotomy (trauma)

• Abdominal compartment syndrome requiring decompression

• Severe peritonitis or sepsis where delayed closure is safer

• Massive bowel edema preventing safe closure

• Postoperative abdominal infection with need for repeated re-exploration

What are the contraindications of NPWT in open abdomen

• Untreated ongoing bleeding

• Unprotected bowel or vessels (no visceral layer)

• Malignancy in the wound

• Necrotic tissue not yet debrided