Skin and Soft Tissue – Surgical Issues

• Various classification systems for necrotizing skin and soft tissue infections help in the study of the disease, doesn’t necessarily help in the care of the patient.
• Dish water exudates and grey necrotic tissue are macroscopic findings of necrotizing soft tissue infection.
• Along with early debridement, very broad spectrum IV antibiotics is the mainstay of necrotizing soft tissue infection.
• Hyperbaric oxygen is not a proven therapy of necrotizing soft tissue infection.
• Switching from castille soap to a once daily 2% chlorhexidine body wash reduces MRSA colonization rates of Surgical ICU patients.
• MRSA (Methicillin Resistant Staphylococcus Aureus) is currently the leading pathogen of surgical site infection
• Chloraprep (contains alcohol) use must be selective – beware of starting a fire on the surgical site.
• After fasciotomies, negative wound therapy could be helpful for getting rid of edema and keeping wound clean and dry.
• Negative pressure wound systems have been associated with complications of death and injuries.
• Measuring compartment pressures, position of the head and trunk relative to the extremities is important when zeroing the transducer
• When performing a Fasciiotomy – one approach anterolateral incision and then posteromedial incision
• Calciphylaxis is associated with high calcium phosphorus product (Ca x P).
• Infected Calciphylaxis lesions must be completely excised which is associated with a high mortality rate.
• Pressure sores is a “never” event.
• Smoking cessation is a mainstay of managing hidradenitis supperativa
• Carbon dioxide laser excision is now being tried to treat moderate infections of hidradenitis supperativa (not severe enough for hospitalization).
• Biopsy of complex skin lesions is important for diagnosis
• Pyoderma Gangrenosum – 50-70% will have systemic disease (like inflammatory bowel disease (UC / Crohn’s Disease).