This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (73)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Multiple Disease Entities Requiring a Common Approach

E. Patchen Dellinger, MD

JAMA. 1981;246(15):1717-1721.

Abstract
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)

Author Affiliations
From the Department of Surgery, University of Washington, and Harborview Medical Center, Seattle.

Footnotes
Reprint requests to Department of Surgery ZA-16, University of Washington, School of Medicine, Seattle, WA 98195 (Dr Dellinger).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Case 33-2009 -- A 35-Year-Old Woman with Fever, Abdominal Pain, and Hypotension after Cesarean Section
de Moya et al.
NEJM 2009;361:1689-1697.
FULL TEXT  

A Case Series Describing 118 Patients With Lower Limb Necrotizing Fasciitis
Khanna et al.
INT J LOW EXTREM WOUNDS 2009;8:112-116.
ABSTRACT  

Necrotising fasciitis
Hasham et al.
BMJ 2005;330:830-833.
FULL TEXT  

Predictors of Mortality and Limb Loss in Necrotizing Soft Tissue Infections
Anaya et al.
Arch Surg 2005;140:151-157.
ABSTRACT | FULL TEXT  

Classic diseases revisited: Necrotizing soft tissue infections
Urschel
Postgrad. Med. J. 1999;75:645-649.
ABSTRACT | FULL TEXT  

Necrotizing Soft Tissue Infections of the Chest Wall
Urschel et al.
Ann. Thorac. Surg. 1997;64:276-279.
ABSTRACT | FULL TEXT  

The Changing Pattern of Hemolytic Streptococcal Gangrene
Aitken et al.
Arch Surg 1982;117:561-567.
ABSTRACT