Abdominal locations complicate surgery. In the early stages reopening, cleaning all the residual purulent cavities and extensive sub-cutaneous rinsing are adequate. In later stages, the fact that the cavities must be kept open, and the necessity of extensive parietal sacrifices make the care of these patients considerably more difficult. The causal lesion requires relevant treatment of its own.
In cases of perineal locations, surgery will largely depend on whether or not a colostomy has to be performed. If intestinal resection requires a colostomy the decision is made automatically. More troublesome are the perineal infections where ongoing fecal drainage are at odds with wound management. Therefore colostomy is always to be considered as soon as an infection reaches the anal area58. The colostomy must be carried out in a healthy area to make sure neither the laparotomy scar nor the colostomy orifice become a causeway for the infection. The colic and rectal segment beyond the ostomy must be thoroughly emptied and cleaned. During the same surgical procedure, extensive drainage of the perineal infection must be carried in the same way, but quite separately from the colostomy.
In addition to all the relevant procedures on the point of entry, fasciitis of the facial and cervical locations must include extensive internal and external drainage of all the infected spaces of the face and neck. Considering the size of the incisions and the risk of necrosis of the cutaneous flaps, drainage on the neck should be carried out by long incisions along the sterno-cleido-mastoid muscles, rather than by transverse ones. Mediastinal drainage can be carried out using cervicotomy incisions if the infection is limited in the supra-aortic space. Right thoracotomy becomes a necessity if there is any extension beyond the aortic arch61.
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