Delayed Primary Wound Closure in Upper Extremity Soft Tissue Infections

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Abstract
Deep muscle abscess or bacterial myositis is not an uncommon disease in the tropics. The commonest pathogen involved is Staphylococcus aureus. However, streptococcal myositis is rare. Only a few cases have been reported in literature. Furthermore, streptococcal myositis with extensive necrosis of muscles has not been reported. In two cases of streptococcal myositis with extensive muscle necrosis, both developed severe acute infection with septicaemia. Histologic observations revealed massive necrosis of muscle tissue with acute inflammatory infiltration. This condition, which we designate streptococcal necrotizing myositis should be treated as a separate disease entity. It requires not just incision and drainage, as in bacterial myositis, but radical excision of all the necrotic muscles in addition to appropriate antibiotics. Unless it is recognized, the treatment will be inadequate and un-necessarily prolonged. Intramuscular pressure may contribute to the pathogenesis of muscle necrosis and may stimulate compartmental syndrome.

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