In decubitus ulcers adequate pressure relief and further protection of vulnerable areas is needed. Surgical management of diabetic foot and decubitus ulcers includes unroofing of encrusted areas and wound probing to determine the extent of tissue destruction and potential bone involvement. The wound can be treated, primarily by skin grafting or flaps or secondarily by wound contraction. Topically applied antibacterial agents include organic synthetic iodide preparations, silver sulfadiazine, and mafenide cream. Surgical debridement and drainage should be performed in those with deep tissue necrosis or suppuration. Infected cysts and subcutaneous abscesses should be promptly drained.
2. Brook I; The role of anaerobic bacteria in skin and soft tissue abscesses and infected cysts. anaerobes 3:171-7, 2007.
2b.Danic Hadzibegovic A, Sauerborn D, Grabovac S, Matic I, Danic D.Necrotizing fasciitis of the neck after total laryngectomy. . 2012 Mar 21.
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Table 1. Clinical presentations of soft tissue infections.
Moderate to high
Minimal or absent
Anaesthesia of lesions
Appearance of infection
Subcutaneous tissue and fascial necrosis. Overlying skin necrotic and dark
Significant oedema. Yellow-brown discolouration of skin. Brown bullae. Necrotic area composed of green-black patches. Serosanguinous discharge
Necrotic central ulcer, dusky margin and erythematous periphery
Crepitus cellulitis with foul-smelling, thick discharge from necrotic skin
Black discharge with surrounding erythema
Table 2. Bacterial aetiology.
Impetigo and cellulitis, diabetic and chronic skin ulcers
Streptococcus group A
Anaerobic oral flora (Prevotella, Fusobacterium and Peptostreptococcus spp.) around oral area and head and neck
Colonic flora: Enterobacteriaceae and anaerobes (i.e. Escherichia coli and Bacteroides fragilis group) around rectum and lower extremity
Streptococcus group A (rarely also groups C or E)
Enteric or oral anaerobes
Gas gangrene and crepitus cellulitis
Clostridium perfringens and other Clostridium species
Progressive bacterial gangrene
Streptococcus groups A, B, C and G
Clostridium spp. (especially perfringens)
Table 3. Risk factors for soft tissue and muscular infections.
Skin and subcutaneous infection
Progressive bacterial synergistic gangrene
―Surgery, draining sinus trauma
Synergistic necrotizing cellulitis
―Trauma, diabetes, myxoedema, abdominal surgery, steroid
and non-steroidal anti-inflammatory, varicella
Clostridial myonecrosis (gas gangrene)
―Diabetes, corticosteroid therapy, trauma
Necrotizing cutaneous mucormycosis
―Diabetes, corticosteroid therapy
Bacterial pseudomonal gangrenous cellulitis
―Ulcerative colitis, rheumatic fever