Upper extremity infection
From Medical-Wiki
Most significant upper extremity infections follow significant trauma, although there are episodes serious enough to require amputation involving trauma that is quite minor. This means that rubor, dolor, calor, and swelling can never be ignored, even in the setting of a healthy population.[1]
It is a combination of the amount of tissue damage and the infecting organism that appear to determine a clinical course. Crush injuries, for example, have a tendency to set up an environment conducive to rampant infection because of the amount of tissue necrosis. Thus, a dirty crush injury needs aggressive management from the outset. This management becomes a compromise between salvage of important structures, appropriate debridement, control of infection, and risk to limb versus risk to life.[2]
Certain organisms have a predilection for producing serious complications. One of these organisms is Aeromonas hydrophila, a water borne organism. There are a great number of reports of fast spreading infections, some requiring full plane debridement, following water sport injuries.[3]
Mycobacterium marinum is another water borne organism that can play a role as an opportunist. It has been associated with outbreaks of infection from a swimming pool as a source, but when seen in an isolated setting, it is sometimes difficult to recognize.
However, the classic infection, associated historically with countless amputations, is Clostridium, the organism responsible for gas gangrene. Factors associated with Clostridium infection include, immunosuppression, diabetes mellitus, vascular disease, trauma, surgery, foreign bodies, malignancy, cold, shock, edema and infection with aerobic microbes.[4]
The ever increasing use of cannulation of vessels has increased the incidence of nosocomial staphylococcus sepsis and soft tissue infections. The concomitant rise of multiply resistant Staphylococcus aureus (MRSA) has returned the treatment of some patients to an environment not unlike that seen 70 years ago where aggressive surgery is the only available option.[5]
Given the fact that some populations, like premature infants, are at increased risks in all regards because of compromised immune status and the necessity of ongoing procedures, the problem of soft tissue infections and subsequent sepsis is always imminent.[6]
