Table 1 Clinical findings in three case reports

Preexisting medical conditions

DM type-II, hypertension, alcohol abuse, heart disease, peripheral vascular and pulmonary disease, malnutrition, chronic wound (pressure sores, diabetes and venous ulcer)

DM type I, hypertension, paraplegia, obesity, heart disease, peripheral. vascular and pulmonary disease, immune deficiency, pressure sores

hypertension, alcohol abuse,

peripheral vascular disease

Physical findings

swelling, erythema, redness, induration, crepitus, pain, fever, warm skin, blisters, skin discoloration, numbness, soft tissue emphysema, confusion, weakness, skin sloughing/necrosis

induration, pain, crepitus, fever, warm skin, blisters, skin discoloration, soft tissue emphysema, paraplegia confusion, numbness

swelling, erythema, redness, induration, crepitus, pain, fever, warm skin, blisters, soft tissue emphysema, confusion, weakness, skin sloughing/necrosis

Vital sings and laboratory valves

SIRS and signs of systemic toxicity, positive LRINEC scour system.

SIRS and signs of systemic toxicity, positive LRINEC scour system.

SIRS and signs of systemic toxicity, positive LRINEC scour system

Source of infection

skin abscess/furunculosis

perineal abscesses, Fournier's gangrene

inguinal hernia repair, bowel perforation.

Microbiology findings

aerobes and anaerobes

aerobes and anaerobes

aerobes and anaerobes

Treatment modalities:

primary debridement

yes

yes

yes

operative intervals (days):

   admission to first debridment

3 hours

6 hours

72 hours

   first to last debridment

2

5

5

   first debridement. to final closure

14 days

12 days

12 days

   days to granulation tissue formation

7 days

10 days

10 days

   hydrofiber dressing

yes

yes

yes

Adjuvant HBO therapy

yes

yes

yes

HBO sessions

4 sessions

11 sessions

11 sessions

Combination of antibiotics used

Penincillin G, Clindamycin, Imipenem, Teicoplanin

Penicilin G, Gentamycin, Clyndamicin

Penicilin G, Gentamycin, Clyndamicin, Metronidazol

Outpatient treatment

oral anti-diabetic drugs, antihypertensive drugs, cardiotonics

Insulin therapy, antihypertensive drugs, cardiotonics, different types of peroral antibiotics for 2 months

antihypertensive drugs, cardiotonics,

ICU therapy

dominantly mechanical ventilation, nutritional support, whole blood, fresh frozen plasma, erythrocyte concentrate, combination of 4 antibiotics (AB) which depending on wound culture or blood culture (administered for 10 days and target AB for 18 days)

dominantly dialysis, nutritional support, blood whole blood, fresh frozen plasma, erythrocyte concentrate combination of 3 antibiotics which depending on wound culture or blood culture (administered for 10 days and target AB for 11 days)

dominantly nutritional support whole blood, fresh frozen plasma, erythrocyte concentrate combination of 4 antibiotics which depending on wound culture or blood culture (administered for 14 days)

Main complications

delay in diagnosis and first debridement, inadequate serial debridement's, bacteriemia, sepsis, wound infection (MRSA), pressure sores, skin graft lysis

delay in diagnosis and first debridement, inadequate serial debridement, bacteriemia, sepsis, MODS, wound infection-MRSA, skin graft lysis, diverting colostomy, pressure sores

delay in diagnosis and first debridement, inadequate serial debridement, bowel perforation, bacteriemia, sepsis, secondary peritonitis, MODS, wound infection(MRSA), diverting colostomy, pressure sores

Reconstruction

skin grafts (SG), local flaps, topical negative pressure therapy with SG

skin grafts, local flaps, topical negative pressure therapy with SG, component separation technique with biological mesh

direct sutures, local flaps, component separation technique with biological mesh