Lecture 9 Surgical Management of Infections Dr. Frush

Question 1

What are the three indications for surgical intervention in a patient presenting with a possible foot infection?

Answer 1

Abscess
Osteomyelitis
Gas producing infection (Medical emergency)

Question 2

What dictates a mild IDSA diabetic foot infection classification?

Answer 2

Cellulitis or erythema >0.5 cm to < 2 cm around ulcer or wound.

The infection is limited to the skin or superficial subq tissue only.

Question 3

What defines a moderate IDSA diabetic foot infection classification?

Answer 3

Erythema >2 cm OR involving deeper structures than skin or subcu tissue.

AND

No signs of SIRS

Question 4

What defines severe IDSA Diabetic foot infection?

Answer 4

Local infection with signs if SIRS

Question 5

What are the four signs of SIRS?

Answer 5

Temp >100.4 (38 C) or < 96.8 (36 C)

RR >20 or PaCO2 <32 mm Hg

Hr >90 Bpm

WBC > 12000 or < 4000
or >10% immature band forms.

Question 6

what are the four D’s of abscess treatment?

Answer 6

Decompression
Drainage
Debridement
Drugs

Question 7

what is the abx duration for mild, moderate and severe levels of IDSA soft tissue infections?

Answer 7

Mild 1-2 weeks topical.

Moderate 1-3 weeks oral

Severe is 2-4 weeks initially parenteral then switch to oral when possible.

Question 8

Most common type of gas producing infection seen in diabetics?

Answer 8

Nonclostridial myonecrosis/necrotizing fasciitis.

Most commonly from Group B strep.

Occurs much slower than Clostridial myonecrosis. Skin changes are dusy to black.

Question 9

What gas is formed by clostridial myonecrosis?

Answer 9

Hyrogen sulfide

Carbon dioxide