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Surgical Wound Infections and Management
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Surgical Wound Infections and Management

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Rehabilitation".

Deadline for manuscript submissions: 31 May 2025 | Viewed by 1355

Special Issue Editors

Prof. Dr. Sharon Henry

E-Mail Website
Guest Editor
Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD 21201, USA
Interests: soft tissue infections
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Marcelo A. F. Ribeiro Jr.

E-Mail Website
Guest Editor
Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD 21201, USA
Interests: trauma; acute care surgery; wounds; open abdomen
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Surgical wound infections represent a significant challenge in postoperative care, contributing to extended hospital stays, increased medical costs, and heightened patient morbidity and mortality. We will provide a review of the state of our current knowledge of this problem. This Special Issue will explore the multifaceted aspects of these infections, providing a comprehensive resource for medical professionals.

Epidemiology and Incidence:

This section will cover the global and regional prevalence of surgical wound infections, highlighting trends and incidences. Understanding the epidemiology is crucial for developing targeted prevention strategies.

Groups Affected:

Focus will be given to vulnerable populations, including the elderly, immunocompromised patients, and those with comorbidities such as diabetes. This will shed light on risk factors and the need for tailored preventive measures. Burn wound infections are a particularly vexing problem. Approaches to the diagnosis and management of this difficulty problem will also be explored.

Medical and Surgical Treatments:

We will delve into the latest advancements in medical and surgical treatments, including prophylactic antibiotics, antiseptic techniques, guidelines, protocols, and innovative surgical approaches. Articles will explore evidence-based practices and emerging therapies aimed at reducing infection rates.

Outcomes and Complications:

We will examine the short- and long-term outcomes of surgical wound infections, addressing potential complications such as sepsis, delayed wound healing, and chronic pain. Understanding these outcomes is essential for improving patient care and recovery processes.

You may choose our Joint Special Issue in Bioengineering.

Prof. Dr. Sharon Henry
Prof. Dr. Marcelo A. F. Ribeiro Jr.
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • surgical wound infections
  • epidemiology
  • incidence
  • risk factors
  • prophylactic antibiotics
  • antiseptic techniques
  • patient outcomes
  • complications
  • postoperative care
  • vulnerable populations
  • burn wound infection
  • antimicrobials
  • bioengineered materials for wounds and infections

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (4 papers)

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Research

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15 pages, 1145 KiB  
Article
Managing Necrotizing Soft Tissue Infections of the Lower Limb: Microsurgical Reconstruction and Hospital Resource Demands—A Case Series from a Tertiary Referral Center
by Georgios Karamitros, Michael P. Grant, Sharon Henry and Gregory A. Lamaris
J. Clin. Med. 2025, 14(9), 2997; https://doi.org/10.3390/jcm14092997 - 26 Apr 2025
Viewed by 249
Abstract
Background: Necrotizing soft tissue infections (NSTIs) of the lower extremities represent a surgical emergency with high morbidity, complex reconstruction, and considerable healthcare demands. Free tissue transfer (FTT) is increasingly utilized for limb salvage in extensive soft tissue defects, yet its implications for hospital [...] Read more.
Background: Necrotizing soft tissue infections (NSTIs) of the lower extremities represent a surgical emergency with high morbidity, complex reconstruction, and considerable healthcare demands. Free tissue transfer (FTT) is increasingly utilized for limb salvage in extensive soft tissue defects, yet its implications for hospital resource utilization remain unclear. This study aims to compare clinical outcomes and perioperative resource demands between FTT and local flap (LF) reconstruction in NSTI patients. Methods: A retrospective case series was conducted at a tertiary referral center between September 2022 and January 2025, including eight patients with NSTI of the lower extremity (FTT, n = 4; LF, n = 4). Demographic data, comorbidities, surgical timing, complication profiles, and resource utilization metrics—including operative duration, hospitalization length, and number of procedures—were analyzed. All FTT cases underwent preoperative CT angiography as part of institutional protocol. Results: Mean time to definitive reconstruction was longer in the FTT group (17.25 vs. 8 days, p = 0.15), reflecting staged infection control. FTT procedures demonstrated significantly longer operative times (331.75 vs. 170.25 minutes, p = 0.015), but there was no significant difference in total hospital stay (34.75 vs. 27.71 days, p = 0.65). No cases of flap loss or venous congestion were observed, and outcomes were optimized via delayed dangling protocols. Conclusions: FTT is a viable and effective reconstructive modality for lower extremity NSTIs. Despite increased surgical complexity, FTT did not significantly increase hospital resource utilization, supporting its role in limb preservation among appropriately selected patients. Full article
(This article belongs to the Special Issue Surgical Wound Infections and Management)
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Review

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13 pages, 1387 KiB  
Review
Advanced Wound Care Strategies in Patients with NSTIs
by Taylor Miller and Jaclyn Clark
J. Clin. Med. 2025, 14(10), 3514; https://doi.org/10.3390/jcm14103514 - 17 May 2025
Viewed by 230
Abstract
Necrotizing soft tissue infections (NSTIs) are rapidly progressive, life-threatening infections associated with significant morbidity and mortality. Surgical debridement, the cornerstone of treatment, often results in extensive, complex wounds located in anatomically difficult regions. Management of these wounds can be challenging, especially for surgeons [...] Read more.
Necrotizing soft tissue infections (NSTIs) are rapidly progressive, life-threatening infections associated with significant morbidity and mortality. Surgical debridement, the cornerstone of treatment, often results in extensive, complex wounds located in anatomically difficult regions. Management of these wounds can be challenging, especially for surgeons with limited experience in complex wound care and reconstruction. Yet, proper management of these wounds is critical to patient recovery and long-term quality of life. This review provides a comprehensive overview of current strategies in NSTI wound reconstruction. It begins by outlining the biological underpinnings of wound healing and the unique challenges posed by NSTI-related wounds. The review then explores a range of dressing materials and advanced wound care modalities, including negative pressure wound therapy, cellular and tissue-based products, and hyperbaric therapy. Finally, it presents a guide to surgical reconstruction techniques, including skin grafting and flap coverage. By consolidating current knowledge and practical guidance, this review seeks to support generalist and acute care surgeons with the knowledge needed to optimize wound healing, enhance functional outcomes, and improve quality of life for NSTI survivors. Full article
(This article belongs to the Special Issue Surgical Wound Infections and Management)
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11 pages, 238 KiB  
Review
The Role of Hyperbaric Oxygen Therapy in Management of Necrotizing Soft Tissue Infection
by Thomas J. Gregory and Kinjal Sethuraman
J. Clin. Med. 2025, 14(10), 3511; https://doi.org/10.3390/jcm14103511 - 17 May 2025
Viewed by 289
Abstract
Necrotizing soft tissue infection (NSTI) is a life-threatening, high morbidity pathology that requires aggressive, multidisciplinary management. Surgery and antibiotic administration are core components of treatment. Adjunctive incorporation of hyperbaric oxygen therapy (HBOT) can further enhance treatment and recovery. Benefit is achieved through multiple [...] Read more.
Necrotizing soft tissue infection (NSTI) is a life-threatening, high morbidity pathology that requires aggressive, multidisciplinary management. Surgery and antibiotic administration are core components of treatment. Adjunctive incorporation of hyperbaric oxygen therapy (HBOT) can further enhance treatment and recovery. Benefit is achieved through multiple effects brought about by increase of local and systemic oxygen tension. Direct effects include bacteriostasis, disruption of bacterial toxin production, and attenuation of inflammation. Indirect benefits include demarcation of viable tissue to enhance surgical efforts, potentiation of antibiotics, and enhancement of immune system function. Overall, HBOT has few contraindications and is typically well tolerated by patients. Treatment course and appropriateness of individual patients can be determined through consultation with Hyperbaric Medicine specialists. The benefits of HBOT in morbidity and mortality of NSTI have been well demonstrated and this therapy should be considered as a component of care to all affected patients. Full article
(This article belongs to the Special Issue Surgical Wound Infections and Management)
12 pages, 235 KiB  
Review
Nutritional Support for Necrotizing Soft Tissue Infection Patients: From ICU to Outpatient Care
by Eftikhar A. Akam, Stacy L. Pelekhaty, Caitlin P. Knisley, Michael G. Ley, Noah V. Loran and Eric J. Ley
J. Clin. Med. 2025, 14(9), 3167; https://doi.org/10.3390/jcm14093167 - 3 May 2025
Viewed by 427
Abstract
Although nutrition recommendations for patients with necrotizing soft tissue infections (NSTIs) often parallel those for patients with burn injuries, differences in the metabolic response to stress indicate that NSTIs require a unique approach. The sepsis and wound management associated with NSTIs trigger a [...] Read more.
Although nutrition recommendations for patients with necrotizing soft tissue infections (NSTIs) often parallel those for patients with burn injuries, differences in the metabolic response to stress indicate that NSTIs require a unique approach. The sepsis and wound management associated with NSTIs trigger a metabolic response, driven by inflammatory and neuroendocrine changes, that leads to high circulating levels of cortisol, catecholamines, insulin, and pro-inflammatory cytokines. This metabolic response follows four phases of recovery (Early Acute; Late Acute; Persistent Inflammation, Immunosuppression, and Catabolism Syndrome; Recovery) that require a thoughtful approach to nutrition by risk screening, malnutrition assessment, and micronutrient deficiency assessment. Close monitoring of energy expenditure and protein needs is required for appropriate nutrition management. Nutrition intake after transfer from the intensive care unit and hospital discharge is often inadequate. Ongoing monitoring of nutrition intake at all outpatient follow-up appointments is necessary, regardless of the route of delivery, until the nutrition status stabilizes and any nutritional decline experienced during hospitalization has been corrected. Full article
(This article belongs to the Special Issue Surgical Wound Infections and Management)
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