Lege Artis Medicinae

[Necessity of a shift in attitudes in the judgment and therapy of skin and soft-tissue infections]

SZALKA András

JUNE 10, 2009

Lege Artis Medicinae - 2009;19(04-05)

[Skin and soft-tissue infections are defined as infections of the epidermis, dermis, or subcutan tissue. They are among the most common human bacterial infections observed in clinical practice. It has also been shown that the incidence of skin and soft-tissue infections is increasing. This has been attributed to several factors, including increasing population age, surgical wounds related to more invasive surgery in the ageing population, obesity, malnutrition, diabetes, peripheral vascular disease and decreasing immunocompetence. There has been a major increase in the occurrence of Staphylococcus aureus infections, and communityacquired methicillin-resistant S. aureus (MRSA) infections in particular. Although many cases of skin and soft-tissue infections can be successfully treated using empirical antimicrobial therapy, changing resistance patterns of S. aureus isolates necessitate new treatment strategies.]

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[INTRODUCTION - Perianal manifestations of Crohn’s disease are common. Treatment of advanced complications like strictures and incontinence may require a radical surgical intervention. We present a case of an extremely rare manifestation of Crohn’s disease. The disease localized exclusively to the anal canal for more than twenty years was complicated by an extensive perianal septic lesion. Besides our own surgical strategy, we discuss in detail other therapeutic options for perianal septic complications of Crohn’s disease. CASE REPORT - During 16 years of disease course the perianal process of the 34 year old female patient caused sphincter destruction and incontinence, and furthermore resulted in a chronic septic state by fistulous tracts involving the whole perineo-gluteal region. Following rectal extirpation, we performed a radical excision and a reconstructive operation using musculo- cutaneous/fascio-cutaneous advancement flaps. The final result of multiple operations of two years’ duration was functionally and aesthetically excellent. CONCLUSION - Fistulous tracts of perianal Crohn’s disease destructing widely their surroundings can only be cured by the radical excision of involved tissues. Extremely large consequent defects can also be covered with proper functional results by methods applying healthy tissues of good loadability i.e. musculocutaneous/ fascio-cutaneous advancement flaps.]

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