Toxic shock syndrome surgery

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Overview

One of the symptoms of streptococcal toxic shock syndrome is extreme infection of the skin and deeper parts is called necrotizing fasciitis. This often requires prompt surgical treatment.

• Although every medical reference continously announce that early surgical debridement in STSS patients can lead to better management of the disease, there are no enough studies to suggest this ideaM. Schurr, S. Engelhardt, R. Helgerson
• Limb salvage for streptococcal gangrene of the extremity
• Am J Surg, 175 (1998), pp. 213–217

• Prompt, aggressive exploration and debridement of patients thought to have deep-seeded pyogenic infection constitutes a surgical emergency. Surgical exploration through a small incision with visualization of the muscle and fascia may provide an early and definitive diagnosis of necrotizing fasciitis. Infection often is more extensive than is apparent from external examination. Surgical debridement of infected tissue is extremely important and often requires re-exploration to ensure adequacy of resection.A.K. May
• Skin and soft tissue infections: the new surgical infection society guidelines
• Surg Infect (Larchmt), 12 (2011), pp. 179–184
• R.P. Dellinger, M.M. Levy, J.M. Carlet, et al.
• Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock
• Crit Care Med, 2008 (36) (2008), pp. 296–327
• D.L. Stevens
• Infections of the skin muscles, and soft tissues
• D.L. Longo, A.S. Fauci, D.L. Kasper (Eds.), et al., Harrison's principles of internal medicine, McGraw-Hill, New York (2012)

The recommendation of immediate radical excision of necrotic tissue in patients with STSS NF is not supported by clinical studies and should be reconsidered.M. Kotb. Bacterial pyrogenic exotoxins as superantigens. Clin Microbiol Rev, 8 (1995), pp. 411–426

Early and immediate surgical debridement should be considered in most patients with suspected streptococcal toxic shock syndrome (i.e., those who present with fever, pain, soft-tissue swelling, and/or vesicle and bullae formation).

Aggressive surgical debridement of infected tissue including fascia is imperative and mandatory if a site of potential infection is identified. Repeated and sequential operative and bedside debridements of infected tissue are often needed, particularly if necrotizing fasciitis is present in streptococcal disease. [null [19]]

In addition to surgical debridements, fasciotomy or amputation may be needed to halt the progression of the disease.Stevens DL, Tanner MH, Winship J, et al. Severe group A streptococcal infections associated with a shock-like syndrome. N Engl J Med. 1989;321:1-7

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