2. Simple focal infections
Impetigo contagiosa – minor skin abrasion – normally caused by S aureus or S pyogenes
Folliculitis – staphylococcal pyodermas of the hair follicles which may coalesce to form
carbuncles
Necrotising focal infections
Bacterial synergistic gangrene – can be wet or gas gangrene
Fournier’s gangrene (located in the scrotum or perineum) – this is a location-specific
form of necrotising fasciitis
Toxic non-necrotising focal infections
Staph scaled skin syndrome
Toxic shock syndrome
Ref for the following slides: Stevens, D.L., et al., Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infections
diseases society of America. CID, 2014. 59: p. 10-50.
5. Simple abscesses
Incision to known area of abscess
Along langer’s lines where possible
Remove all infected tissue
Generally not for primary closure
Complex infections such as
carbuncles
Excise whole area of infection
Some evidence that skin grafts can be
done primarily however this is not
common practice
Post-operative antibiotics do not affect
wound healing but may reduce rates of
recurrence in simple abscesses and
carbuncles
6. Most breast abscesses develop as a
complication of lactational mastitis
I&D yields lower recurrence rate BUT
results in
scarring,
structural damage,
risk of milk fistula,
painful breastfeeding,
prolonged healing times,
poor cosmesis
Therefore US guided needle aspiration
+/- drain insertion is treatment of
choice in most cases
Post acute infection, may be need for
excision of damaged/chronically
inflamed tissueRef:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3335354/pdf/brc-0007-0032.pdf
http://iahealth.net/breast-abscess-and-mastitis/
BMJ Best Practice
Image redacted for uploaded edition
Please google breast abscesses to
find your own!
7. Agostini, T., et al., Successful
combined approach to a severe
Fournier’s gangrene. Indian Journal of
Plastic Surgery, 2014. 41(1): p. 132-
136.
https://radiopaedia.org/articles/fournie
r-gangrene
https://www.researchgate.net/figure/Fo
urniers-gangrene-of-the-
scrotum_fig2_221915361
Recommended
reading!!
8. Three concentric zones of erythema,
cyanosis and necrosis at the site of
synergistic infection
Often a small cut, bruise or abrasion
as the initial trigger
Common skin bacteria with
superimposed (synergistic) bacteria
C. perfringens creates gas gangrene
Treatment is multimodal
IVF
Vasopressors if required
Broad spectrum Abx covering gram
positive and gram negative as well an
anaerobic bacteria – e.g. vanc +
tazocin or vanc meropenem or vanc +
ceftriaxone + metronidazole or vanc +
ciprofloxacin + metronidazole
Urgent debridement in theatre – down
to underlying healthy tissue. Any
plane that separates easily with blunt
dissection should be considered
involved
Delayed reconstruction
9. Many skin and soft tissue infections
can be managed conservatively
Antibiotic use is generally to cover
common skin bacteria that have
breached the skin immune barrier
through minor trauma
US-guided needle aspiration can be
used for breast abscesses
UNLESS the abscess is >5cm in which
case I&D should be considered
Incision and drainage is the
mainstay of treatment for skin
abscesses
Excision is the mainstay of
treatment for carbuncles
Antibiotics post-op help reduce risk
of recurrence
Necrotising fasciitis and fournier’s
are surgical emergencies requiring
extensive debridement down to
healthy tissue (sometimes
amputation) as well as broad
spectrum antibiotics and IVF and
often vasopressor support
Notas do Editor
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3335354/pdf/brc-0007-0032.pdf
http://iahealth.net/breast-abscess-and-mastitis/
BMJ Best Practice
Agostini, T., et al., Successful combined approach to a severe Fournier’s gangrene. Indian Journal of Plastic Surgery, 2014. 41(1): p. 132-136.
https://radiopaedia.org/articles/fournier-gangrene
https://www.researchgate.net/figure/Fourniers-gangrene-of-the-scrotum_fig2_221915361