Mandatory Operative Re-Exploration after Initial Debridement of Necrotizing Soft Tissue Infections: Is it Mandatory?

Abstract

Necrotizing soft tissue infections (NSTIs) are aggressive infections requiring prompt diagnosis and extensive surgical debridement. Traditionally, patients undergo mandatory re-exploration to ensure adequacy of source control. The purpose of this study is to determine if re-exploration in the operating room is mandatory for all patients with NSTIs. An eight-year retrospective analysis of adult patients with NSTIs was performed comparing two groups: mandatory operative re-exploration versus operative re-exploration based on clinical examination findings. Outcomes measured included mortality, number of debridements, and length of stay (LOS). Twenty-two per cent of patients underwent a mandatory re-exploration. These patients were older, had a higher incidence of diabetes, and a longer duration of symptoms. There were no significant differences between groups with regard to the physical examination, severity of sepsis, time to repeat debridements, or in-hospital mortality, whereas LOS and the total number of debridements were increased in mandatory re-exploration. Bacteremia and septic shock were predictive of the need for further debridement in patients in the operative re-exploration based on clinical examination findings group. Mandatory re-exploration after initial debridement may not be necessary in all patients with NSTIs. Instead, bedside wound checks may be a safe strategy to determine the need for further operative debridement.

• Authors: Lara H Spence, Huan Yan, Ashkan Moazzez, Alexander Schwed, Jessica Keeley, Mohammad Karimzada, Mari Allison, Angela Neville, David Plurad, Brant Putnam, Christian de Virgilio, Dennis Kim
• Journal: The American surgeon (Am Surg) Vol. 83 Issue 10 Pg. 1117-1121 (Oct 01 2017) ISSN: 1555-9823 [Electronic] United States
• PMID: 29391107 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Case-Control Studies
• Debridement
• Female
• Humans
• Length of Stay
• Logistic Models
• Male
• Middle Aged
• Necrosis (diagnosis, mortality, surgery)
• Reoperation
• Retrospective Studies
• Soft Tissue Infections (diagnosis, mortality, surgery)