Tedesco Silvia, Di Grezia Marta, Tropeano Giuseppe, Altieri Gaia, Brisinda Giuseppe
Emergency Surgery and Trauma Center, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli, IRCS, 00168, Rome, Italy.
Catholic School of Medicine, "Agostino Gemelli", 00168, Rome, Italy.
Updates Surg. 2025 Apr 28. doi: 10.1007/s13304-025-02222-0.
Necrotizing soft tissue infections represent a spectrum of diseases characterized by extensive necrosis involving the skin, subcutaneous tissues, fascia or muscles. These infections are generally severe and rapidly progressive, often accompanied by sepsis, septic chock, multiple organ failure and, ultimately, death. Several classifications have been developed based on multiple parameters, such as the anatomical location of the disease, the depth of the lesion or the microbiology. Numerous clinical factors predispose individuals to the development of necrotizing soft tissue infections. The clinical presentation is not always characterized by local signs and systemic symptoms of infection, which can lead to delays in both diagnosis ad treatment. Broad-spectrum antibiotic directed at the likely organisms is essential early in the treatment course, but do not substitute surgical management. Antibiotic therapy should be subsequently tailored to the etiologic micro-organism. Rapid recognition and early surgical intervention form the mainstay of management of necrotizing soft tissue infections. Initial surgical debridement should be promptly performed preferably at the presenting hospital, when adequate infrastructure and personnel are available. Transfer to a referral center may be necessary for definitive surgical and complex wound care. Most patients require more than one debridement. A multidisciplinary approach is also essential to improve the results in the treatment of these patients.
坏死性软组织感染是一类疾病，其特征为皮肤、皮下组织、筋膜或肌肉发生广泛坏死。这些感染通常较为严重且进展迅速，常伴有脓毒症、感染性休克、多器官功能衰竭，最终导致死亡。基于多种参数，如疾病的解剖位置、病变深度或微生物学等，已制定了多种分类方法。众多临床因素使个体易患坏死性软组织感染。临床表现并不总是以感染的局部体征和全身症状为特征，这可能导致诊断和治疗的延迟。在治疗过程早期，针对可能的病原体使用广谱抗生素至关重要，但不能替代手术治疗。随后应根据病原微生物调整抗生素治疗。快速识别和早期手术干预是坏死性软组织感染治疗的主要手段。初始手术清创应尽快进行，最好在患者就诊的医院进行，前提是有足够的基础设施和人员。对于确定性手术和复杂伤口护理，可能需要转至转诊中心。大多数患者需要进行不止一次清创。多学科方法对于改善这些患者的治疗效果也至关重要。
