Toxic shock syndrome surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]
Overview:
Surgery is not the first-line treatment option for patients with toxic shock syndrome(TSS). Surgical debridement is usually reserved for patients with either necrotizing fasciitis(NF), and patients with deep-seeded pyogenic infection.
Urgent surgical debridement was recommended for all patients who develop NF earlier, but is under questioning nowadays.
ne 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 idea.
- 9560122
The recommendation of immediate radical excision of necrotic tissue in patients with STSS NF is not supported by clinical studies and should be reconsidered.[1]
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]] [2] 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 [3]
Surgery
Prompt, aggressive, immediate exploration and debridement of patients thought to have deep tissue localized infection was believed to be a surgical emergency [4]. Surgical exploration of the susceptible infected tissue may help with the early and definitive diagnosis of NF. In NF related TSS patients, infection usually is more extensive than is apparent from external examination. Although the necessity of surgical debridement, the recommendation of immediate radical excision of necrotic tissue in patients with streptococcal TSS NF is not supported by clinical studies and should be reconsidered as an emergency treatment in TSS management.
Indications
Surgical debridement of body tissues should be considered in these patients:
- Localized source of infection is diagnosed
- Streptococcal NF-related TSS patients
References
- ↑ Kotb M (1995). "Bacterial pyrogenic exotoxins as superantigens". Clin. Microbiol. Rev. 8 (3): 411–26. PMC 174633. PMID 7553574.
- ↑ Polna I, Aleksandrowicz J (1975). "Effect of adsorbents on IgM and IgG measles antibodies". Acta Virol. 19 (6): 449–56. PMID 1989.
- ↑ "Chapter 125. Infections of the Skin, Muscles, and Soft Tissues | Harrison's Principles of Internal Medicine, 18e | AccessMedicine | McGraw-Hill Medical".
- ↑ Schurr M, Engelhardt S, Helgerson R (1998). "Limb salvage for streptococcal gangrene of the extremity". Am. J. Surg. 175 (3): 213–7. PMID 9560122.