Minerva chirurgica
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Necrotizing soft tissue infections (NSTIs) are aggressive severe soft tissue infection that cause rapid and widespread infection and necrosis of the skin and soft tissues and are highly lethal. NSTIs include necrotizing cellulitis, adipositis, fasciitis and myositis/myonecrosis and have significant potential for extensive soft tissue and limb loss. Early diagnosis and treatment of NSTIs remains the cornerstone of therapy. ⋯ Mortality rate has decreased from 25-50% in past years, to 10-16% in recent years with aggressive surgical and medical management. Additional innovative strategies for the treatment of NSTIs, including intravenous immuno-globulin G (IVIG), hyperbaric oxygen, and vacuum-assisted closure, do not yet have definitive evidence of efficacy, but may be considered in patients at high risk of death. A comprehensive knowledge of the pathophysiology, diagnostic features, causative microbial pathogens, and treatment strategies (including surgical debridement and antimicrobial therapy) is required for successful management of NSTIs.
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Acute limb ischemia (ALI) is one of the most common vascular emergencies and characterized by sudden worsening of limb perfusion mainly caused by embolization of thrombotic masses or acute graft occlusion. It is a serious condition with potential thread to limb viability accompanied by significant mortality, morbidity and costs. This article provides an overview of etiology, classification and treatment options of ALI ischemia with special focus on the issue of postreperfusion syndrome. The concept of reperfusion injury following limb ischemia and a system for controlled limb reperfusion to offset postreperfusion synsrome is described in detail.