Necrotizing Soft-Tissue Infections: A Retrospective Review of Predictive Factors for Limb Loss
Emergent diagnosis and treatment are important for the survival of patients with necrotizing soft-tissue infections (NSTIs). Death is the most catastrophic outcome, but limb loss is also one of the most important complications that can have a significant impact on the rest of the patient's life...
Gespeichert in:
| Veröffentlicht in: | Clinics in orthopedic surgery Jg. 14; H. 2; S. 297 - 309 |
|---|---|
| Hauptverfasser: | , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
| Veröffentlicht: |
Korea (South)
The Korean Orthopaedic Association
01.06.2022
대한정형외과학회 |
| Schlagworte: | |
| ISSN: | 2005-291X, 2005-4408, 2005-4408 |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| Abstract | Emergent diagnosis and treatment are important for the survival of patients with necrotizing soft-tissue infections (NSTIs). Death is the most catastrophic outcome, but limb loss is also one of the most important complications that can have a significant impact on the rest of the patient's life. The purpose of this study was to identify predictive factors for limb loss caused by NSTIs.
The data of patients at our center who were diagnosed with NSTIs from May 2003 to January 2019 were analyzed retrospectively. The inclusion criteria were patients with a definite diagnosis of NSTI involving the upper or lower limb. A total of 49 patient records were analyzed in terms of demography, laboratory data, microbiological causes, treatment, and final outcome. Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scores at initial admission were also collected as laboratory data. Final outcomes were classified into survival with limb salvage and survival with limb loss.
The limb loss rate was 20.4% (10/49) in our study. On comparison between the limb salvage group and the limb loss group, independent risk factors of limb loss were as follows: presence of hypotension at admission (odds ratio [OR], 8.2; 95% confidence interval [CI], 1.7-38.3;
= 0.008); LRINEC score ≥ 9 (OR, 5.8; 95% CI, 1.3-25.6;
= 0.012), and glucose level > 300 mg/dL (OR, 4.5; 95% CI, 0.9-21.9;
= 0.041). Various microbiological organisms were isolated; the most prevalent specimen was streptococci (32.6%), followed by staphylococci (26.5%). Poor outcomes including limb loss and mortality had no correlation with microbiological organisms.
For patients with NSTIs, the presence of hypotension at admission, a high glucose level (> 300 mg/dL), and a high LRINEC score (> 9) were independent risk factors for limb loss. |
|---|---|
| AbstractList | Background: Emergent diagnosis and treatment are important for the survival of patients with necrotizing soft-tissue infections (NSTIs). Death is the most catastrophic outcome, but limb loss is also one of the most important complications that can have a significant impact on the rest of the patient’s life. The purpose of this study was to identify predictive factors for limb loss caused by NSTIs.
Methods: The data of patients at our center who were diagnosed with NSTIs from May 2003 to January 2019 were analyzed retrospectively. The inclusion criteria were patients with a definite diagnosis of NSTI involving the upper or lower limb. A total of 49 patient records were analyzed in terms of demography, laboratory data, microbiological causes, treatment, and final outcome.
Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scores at initial admission were also collected as laboratory data. Final outcomes were classified into survival with limb salvage and survival with limb loss.
Results: The limb loss rate was 20.4% (10/49) in our study. On comparison between the limb salvage group and the limb loss group, independent risk factors of limb loss were as follows: presence of hypotension at admission (odds ratio [OR], 8.2; 95% confidence interval [CI], 1.7–38.3; p = 0.008); LRINEC score ≥ 9 (OR, 5.8; 95% CI, 1.3–25.6; p = 0.012), and glucose level > 300 mg/dL (OR, 4.5; 95% CI, 0.9–21.9; p = 0.041). Various microbiological organisms were isolated; the most prevalent specimen was streptococci (32.6%), followed by staphylococci (26.5%). Poor outcomes including limb loss and mortality had no correlation with microbiological organisms.
Conclusions: For patients with NSTIs, the presence of hypotension at admission, a high glucose level (> 300 mg/dL), and a high LRINEC score (> 9) were independent risk factors for limb loss. KCI Citation Count: 0 Emergent diagnosis and treatment are important for the survival of patients with necrotizing soft-tissue infections (NSTIs). Death is the most catastrophic outcome, but limb loss is also one of the most important complications that can have a significant impact on the rest of the patient's life. The purpose of this study was to identify predictive factors for limb loss caused by NSTIs.BackgroundEmergent diagnosis and treatment are important for the survival of patients with necrotizing soft-tissue infections (NSTIs). Death is the most catastrophic outcome, but limb loss is also one of the most important complications that can have a significant impact on the rest of the patient's life. The purpose of this study was to identify predictive factors for limb loss caused by NSTIs.The data of patients at our center who were diagnosed with NSTIs from May 2003 to January 2019 were analyzed retrospectively. The inclusion criteria were patients with a definite diagnosis of NSTI involving the upper or lower limb. A total of 49 patient records were analyzed in terms of demography, laboratory data, microbiological causes, treatment, and final outcome. Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scores at initial admission were also collected as laboratory data. Final outcomes were classified into survival with limb salvage and survival with limb loss.MethodsThe data of patients at our center who were diagnosed with NSTIs from May 2003 to January 2019 were analyzed retrospectively. The inclusion criteria were patients with a definite diagnosis of NSTI involving the upper or lower limb. A total of 49 patient records were analyzed in terms of demography, laboratory data, microbiological causes, treatment, and final outcome. Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scores at initial admission were also collected as laboratory data. Final outcomes were classified into survival with limb salvage and survival with limb loss.The limb loss rate was 20.4% (10/49) in our study. On comparison between the limb salvage group and the limb loss group, independent risk factors of limb loss were as follows: presence of hypotension at admission (odds ratio [OR], 8.2; 95% confidence interval [CI], 1.7-38.3; p = 0.008); LRINEC score ≥ 9 (OR, 5.8; 95% CI, 1.3-25.6; p = 0.012), and glucose level > 300 mg/dL (OR, 4.5; 95% CI, 0.9-21.9; p = 0.041). Various microbiological organisms were isolated; the most prevalent specimen was streptococci (32.6%), followed by staphylococci (26.5%). Poor outcomes including limb loss and mortality had no correlation with microbiological organisms.ResultsThe limb loss rate was 20.4% (10/49) in our study. On comparison between the limb salvage group and the limb loss group, independent risk factors of limb loss were as follows: presence of hypotension at admission (odds ratio [OR], 8.2; 95% confidence interval [CI], 1.7-38.3; p = 0.008); LRINEC score ≥ 9 (OR, 5.8; 95% CI, 1.3-25.6; p = 0.012), and glucose level > 300 mg/dL (OR, 4.5; 95% CI, 0.9-21.9; p = 0.041). Various microbiological organisms were isolated; the most prevalent specimen was streptococci (32.6%), followed by staphylococci (26.5%). Poor outcomes including limb loss and mortality had no correlation with microbiological organisms.For patients with NSTIs, the presence of hypotension at admission, a high glucose level (> 300 mg/dL), and a high LRINEC score (> 9) were independent risk factors for limb loss.ConclusionsFor patients with NSTIs, the presence of hypotension at admission, a high glucose level (> 300 mg/dL), and a high LRINEC score (> 9) were independent risk factors for limb loss. Emergent diagnosis and treatment are important for the survival of patients with necrotizing soft-tissue infections (NSTIs). Death is the most catastrophic outcome, but limb loss is also one of the most important complications that can have a significant impact on the rest of the patient's life. The purpose of this study was to identify predictive factors for limb loss caused by NSTIs. The data of patients at our center who were diagnosed with NSTIs from May 2003 to January 2019 were analyzed retrospectively. The inclusion criteria were patients with a definite diagnosis of NSTI involving the upper or lower limb. A total of 49 patient records were analyzed in terms of demography, laboratory data, microbiological causes, treatment, and final outcome. Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scores at initial admission were also collected as laboratory data. Final outcomes were classified into survival with limb salvage and survival with limb loss. The limb loss rate was 20.4% (10/49) in our study. On comparison between the limb salvage group and the limb loss group, independent risk factors of limb loss were as follows: presence of hypotension at admission (odds ratio [OR], 8.2; 95% confidence interval [CI], 1.7-38.3; = 0.008); LRINEC score ≥ 9 (OR, 5.8; 95% CI, 1.3-25.6; = 0.012), and glucose level > 300 mg/dL (OR, 4.5; 95% CI, 0.9-21.9; = 0.041). Various microbiological organisms were isolated; the most prevalent specimen was streptococci (32.6%), followed by staphylococci (26.5%). Poor outcomes including limb loss and mortality had no correlation with microbiological organisms. For patients with NSTIs, the presence of hypotension at admission, a high glucose level (> 300 mg/dL), and a high LRINEC score (> 9) were independent risk factors for limb loss. |
| Author | Park, Hee-Gon Yang, Jong-Heon Yi, Hyung-Suk Park, Byung-Hoon |
| AuthorAffiliation | Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea |
| AuthorAffiliation_xml | – name: Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea |
| Author_xml | – sequence: 1 givenname: Hee-Gon orcidid: 0000-0002-7389-7280 surname: Park fullname: Park, Hee-Gon organization: Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea – sequence: 2 givenname: Jong-Heon orcidid: 0000-0003-2010-8935 surname: Yang fullname: Yang, Jong-Heon organization: Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea – sequence: 3 givenname: Byung-Hoon orcidid: 0000-0001-5038-6835 surname: Park fullname: Park, Byung-Hoon organization: Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea – sequence: 4 givenname: Hyung-Suk orcidid: 0000-0002-2064-2815 surname: Yi fullname: Yi, Hyung-Suk organization: Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/35685976$$D View this record in MEDLINE/PubMed https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART002843828$$DAccess content in National Research Foundation of Korea (NRF) |
| BookMark | eNplkU1vEzEQhi1URD_gwB9APsJhqe2s7TUHpKiiNFIEqE0lTlheZ1xMN3ZqO0Hw6-s0aQBxGnvmmXc08x6jgxADIPSSkrct4fzU-pipokI8QUeMEN60LekOdm-m6NdDdJzzD0IEF5I8Q4cjLjqupDhC3z6BTbH43z7c4KvoSjPzOa8AT4IDW3wM-R0e40soKeblJrOG-lt7-Imjw18SzP02eW5siSljFxOe-kWPpzHn5-ipM0OGF7t4gq7PP8zOLprp54-Ts_G0sa3kpZkb1fXKWTrvLat7UAWuF1wR29vWjkBSJhwxLZBa6FrLJbSs54wxAOWkG52gN1vdkJy-tV5H4x_iTdS3SY8vZxOtlJRkRCr7fssuV_0C5hZCSWbQy-QXJv166Py3Evz3qrPWinLWdbIKvN4JpHi3glz0wmcLw2ACxFXWTEguyObGFX3196z9kEcDKnC6BaoLOSdw2vpiNnevo_2gKdEbi_Xe4j-r7jseRf9n7wGP-Kjs |
| CitedBy_id | crossref_primary_10_1111_iwj_14379 crossref_primary_10_4239_wjd_v15_i4_629 crossref_primary_10_1016_j_arth_2024_10_127 |
| Cites_doi | 10.1097/00006534-199905000-00003 10.1186/s13017-016-0097-y 10.1308/rcsann.2017.0053 10.1097/01.CCM.0000129486.35458.7D 10.1007/s10096-013-2039-x 10.1186/s12879-015-1144-0 10.2106/00004623-200308000-00005 10.1007/s00068-017-0792-8 10.1002/bjs.1800600817 10.1001/archsurg.140.2.151 10.1016/j.jamcollsurg.2008.10.032 10.1007/s00423-014-1162-1 10.3389/fsurg.2014.00036 10.1016/S0140-6736(94)91956-9 10.1086/511638 10.1056/NEJMoa042683 |
| ContentType | Journal Article |
| Copyright | Copyright © 2022 by The Korean Orthopaedic Association. Copyright © 2022 by The Korean Orthopaedic Association 2022 The Korean Orthopaedic Association |
| Copyright_xml | – notice: Copyright © 2022 by The Korean Orthopaedic Association. – notice: Copyright © 2022 by The Korean Orthopaedic Association 2022 The Korean Orthopaedic Association |
| DBID | AAYXX CITATION NPM 7X8 5PM ACYCR |
| DOI | 10.4055/cios19166 |
| DatabaseName | CrossRef PubMed MEDLINE - Academic PubMed Central (Full Participant titles) Korean Citation Index |
| DatabaseTitle | CrossRef PubMed MEDLINE - Academic |
| DatabaseTitleList | MEDLINE - Academic PubMed |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database |
| DeliveryMethod | fulltext_linktorsrc |
| EISSN | 2005-4408 |
| EndPage | 309 |
| ExternalDocumentID | oai_kci_go_kr_ARTI_9977030 PMC9152887 35685976 10_4055_cios19166 |
| Genre | Journal Article |
| GroupedDBID | --- 5-W 53G 8JR 8XY AAYXX ADBBV ADRAZ ALMA_UNASSIGNED_HOLDINGS AOIJS BAWUL BCNDV C1A CITATION DIK E3Z EBD EF. EMOBN F5P FRP GROUPED_DOAJ HYE KQ8 M48 O5R O5S OK1 PGMZT RPM SV3 TR2 W2D 9ZL M~E NPM 7X8 5PM ACYCR |
| ID | FETCH-LOGICAL-c475t-da98b9fc1dbc216619efb6590cbc4c3e7126f0a4e09ef84c57e42b5222ee9f7f3 |
| ISICitedReferencesCount | 4 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=000809660500019&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| ISSN | 2005-291X 2005-4408 |
| IngestDate | Sun Mar 09 07:53:47 EDT 2025 Tue Nov 04 02:05:55 EST 2025 Thu Jul 10 22:06:45 EDT 2025 Wed Feb 19 02:26:01 EST 2025 Sat Nov 29 03:07:32 EST 2025 Tue Nov 18 22:30:16 EST 2025 |
| IsDoiOpenAccess | true |
| IsOpenAccess | true |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 2 |
| Keywords | Necrotizing soft tissue infection Necrotizing fasciitis Amputation |
| Language | English |
| License | Copyright © 2022 by The Korean Orthopaedic Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
| LinkModel | OpenURL |
| MergedId | FETCHMERGED-LOGICAL-c475t-da98b9fc1dbc216619efb6590cbc4c3e7126f0a4e09ef84c57e42b5222ee9f7f3 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 https://doi.org/10.4055/cios19166 |
| ORCID | 0000-0002-2064-2815 0000-0001-5038-6835 0000-0002-7389-7280 0000-0003-2010-8935 |
| OpenAccessLink | http://dx.doi.org/10.4055/cios19166 |
| PMID | 35685976 |
| PQID | 2675603568 |
| PQPubID | 23479 |
| PageCount | 13 |
| ParticipantIDs | nrf_kci_oai_kci_go_kr_ARTI_9977030 pubmedcentral_primary_oai_pubmedcentral_nih_gov_9152887 proquest_miscellaneous_2675603568 pubmed_primary_35685976 crossref_citationtrail_10_4055_cios19166 crossref_primary_10_4055_cios19166 |
| PublicationCentury | 2000 |
| PublicationDate | 2022-06-01 |
| PublicationDateYYYYMMDD | 2022-06-01 |
| PublicationDate_xml | – month: 06 year: 2022 text: 2022-06-01 day: 01 |
| PublicationDecade | 2020 |
| PublicationPlace | Korea (South) |
| PublicationPlace_xml | – name: Korea (South) |
| PublicationTitle | Clinics in orthopedic surgery |
| PublicationTitleAlternate | Clin Orthop Surg |
| PublicationYear | 2022 |
| Publisher | The Korean Orthopaedic Association 대한정형외과학회 |
| Publisher_xml | – name: The Korean Orthopaedic Association – name: 대한정형외과학회 |
| References | Jabbour (10.4055/cios19166_ref10) 2016; 11 Haywood (10.4055/cios19166_ref17) 1999; 103 Anaya (10.4055/cios19166_ref3) 2007; 44 Misiakos (10.4055/cios19166_ref1) 2014; 1 Sarani (10.4055/cios19166_ref4) 2009; 208 Anaya (10.4055/cios19166_ref7) 2005; 140 Leiblein (10.4055/cios19166_ref6) 2018; 44 Lee (10.4055/cios19166_ref11) 2014; 33 Wong (10.4055/cios19166_ref18) 2003; 85 Bechar (10.4055/cios19166_ref13) 2017; 99 Bilton (10.4055/cios19166_ref15) 1998; 64 Howard (10.4055/cios19166_ref19) 1985; 98 Huang (10.4055/cios19166_ref8) 2011; 71 Cheng (10.4055/cios19166_ref16) 2015; 15 Miller (10.4055/cios19166_ref5) 2005; 352 Descamps (10.4055/cios19166_ref2) 1994; 344 Wong (10.4055/cios19166_ref12) 2004; 32 Pugh (10.4055/cios19166_ref14) 1973; 60 Krieg (10.4055/cios19166_ref9) 2014; 399 |
| References_xml | – volume: 71 start-page: 467 issue: 2 year: 2011 ident: 10.4055/cios19166_ref8 publication-title: J Trauma – volume: 64 start-page: 397 issue: 5 year: 1998 ident: 10.4055/cios19166_ref15 publication-title: Am Surg – volume: 103 start-page: 1567 issue: 6 year: 1999 ident: 10.4055/cios19166_ref17 publication-title: Plast Reconstr Surg doi: 10.1097/00006534-199905000-00003 – volume: 98 start-page: 126 issue: 1 year: 1985 ident: 10.4055/cios19166_ref19 publication-title: Surgery – volume: 11 start-page: 40 year: 2016 ident: 10.4055/cios19166_ref10 publication-title: World J Emerg Surg doi: 10.1186/s13017-016-0097-y – volume: 99 start-page: 341 issue: 5 year: 2017 ident: 10.4055/cios19166_ref13 publication-title: Ann R Coll Surg Engl doi: 10.1308/rcsann.2017.0053 – volume: 32 start-page: 1535 issue: 7 year: 2004 ident: 10.4055/cios19166_ref12 publication-title: Crit Care Med doi: 10.1097/01.CCM.0000129486.35458.7D – volume: 33 start-page: 1011 issue: 6 year: 2014 ident: 10.4055/cios19166_ref11 publication-title: Eur J Clin Microbiol Infect Dis doi: 10.1007/s10096-013-2039-x – volume: 15 start-page: 417 year: 2015 ident: 10.4055/cios19166_ref16 publication-title: BMC Infect Dis doi: 10.1186/s12879-015-1144-0 – volume: 85 start-page: 1454 issue: 8 year: 2003 ident: 10.4055/cios19166_ref18 publication-title: J Bone Joint Surg Am doi: 10.2106/00004623-200308000-00005 – volume: 44 start-page: 279 issue: 2 year: 2018 ident: 10.4055/cios19166_ref6 publication-title: Eur J Trauma Emerg Surg doi: 10.1007/s00068-017-0792-8 – volume: 60 start-page: 646 issue: 8 year: 1973 ident: 10.4055/cios19166_ref14 publication-title: Br J Surg doi: 10.1002/bjs.1800600817 – volume: 140 start-page: 151 issue: 2 year: 2005 ident: 10.4055/cios19166_ref7 publication-title: Arch Surg doi: 10.1001/archsurg.140.2.151 – volume: 208 start-page: 279 issue: 2 year: 2009 ident: 10.4055/cios19166_ref4 publication-title: J Am Coll Surg doi: 10.1016/j.jamcollsurg.2008.10.032 – volume: 399 start-page: 333 issue: 3 year: 2014 ident: 10.4055/cios19166_ref9 publication-title: Langenbecks Arch Surg doi: 10.1007/s00423-014-1162-1 – volume: 1 start-page: 36 year: 2014 ident: 10.4055/cios19166_ref1 publication-title: Front Surg doi: 10.3389/fsurg.2014.00036 – volume: 344 start-page: 556 issue: 8921 year: 1994 ident: 10.4055/cios19166_ref2 publication-title: Lancet doi: 10.1016/S0140-6736(94)91956-9 – volume: 44 start-page: 705 issue: 5 year: 2007 ident: 10.4055/cios19166_ref3 publication-title: Clin Infect Dis doi: 10.1086/511638 – volume: 352 start-page: 1445 issue: 14 year: 2005 ident: 10.4055/cios19166_ref5 publication-title: N Engl J Med doi: 10.1056/NEJMoa042683 |
| SSID | ssj0065670 |
| Score | 2.2620919 |
| Snippet | Emergent diagnosis and treatment are important for the survival of patients with necrotizing soft-tissue infections (NSTIs). Death is the most catastrophic... Background: Emergent diagnosis and treatment are important for the survival of patients with necrotizing soft-tissue infections (NSTIs). Death is the most... |
| SourceID | nrf pubmedcentral proquest pubmed crossref |
| SourceType | Open Website Open Access Repository Aggregation Database Index Database Enrichment Source |
| StartPage | 297 |
| SubjectTerms | Original 정형외과학 |
| Title | Necrotizing Soft-Tissue Infections: A Retrospective Review of Predictive Factors for Limb Loss |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/35685976 https://www.proquest.com/docview/2675603568 https://pubmed.ncbi.nlm.nih.gov/PMC9152887 https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART002843828 |
| Volume | 14 |
| WOSCitedRecordID | wos000809660500019&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | 1 |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| ispartofPNX | Clinics in Orthopedic Surgery, 2022, 14(2), , pp.297-309 |
| journalDatabaseRights | – providerCode: PRVAON databaseName: DOAJ Directory of Open Access Journals customDbUrl: eissn: 2005-4408 dateEnd: 99991231 omitProxy: false ssIdentifier: ssj0065670 issn: 2005-291X databaseCode: DOA dateStart: 20090101 isFulltext: true titleUrlDefault: https://www.doaj.org/ providerName: Directory of Open Access Journals |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwtV3db9MwELfawQMvCMRX-ZgMQghpikgTp7Z5G2hlSFVB0EnlBStx7S3qSEraToM_gL-buzhJ06kP44GXtDo7vdb3y_muvg9CXiIIONi1XqKZ9lgkrReLWeIJwWawvQRamrKI64iPx2I6lZ87nT91LszFOc8ycXkpF_9V1EADYWPq7D-Iu_lQIMB7EDpcQexwvZbgx2AI5qv0d1lqG5SsNynXFjSBC7vKli4b_YtZFXmdaFkX2MeIuALPbkrisGrGg6GIo_RHcjDKq3iNurZBmVdZhtTi-U--wFsPlq1U6yqx2u1wxvuwOfX_FtfBwNmpd2w2A_X8d7_WOJK3bnEttkv61_W8_Y8FOLtNZJVTbGX1U-x07fagHbRaM7MWAoO2mnUxvVfVPxifWClDp_kS3NDBjhLb409qeDIaqcnRdPJq8dPD7mN4Sl-1YumSGwGPpKxdc7ejg8lbNh1svqOrUIXc3jS8tuyablbYXS7L1cjblikzuUNuVz4IPXTYuUs6JrtHvrdwQ1u4oRvcvKWHdAs11KGG5pZuUEMr1FBADUXUUETNfXIyPJq8P_aq5hueZjxaebNYikRa3Z8lOoDf15fGJoNI-hqf6tDwfjCwfsyMDwOC6YgbFiRgzQfGSMtt-IDsZXlmHhFqfcFFzJKEhYxpwWNfBn5orWTcCD9OeuR1vXRKV5XpsUHKuQIPFVdZNavcIy-aqQtXjmXnJFh_NdepwuLp-Hqaq3mhwEX8qCR4PLCz9cjzWjwKNCoek8WZyddLFYAPPfDDaCB65KETV8MLqeCCAwu-JchmAjLcHsnSs7JquwRLGXb0x9fg-4Tc2jw3T8neqlibZ-Smvlily2KfdPlU7JcI_QuR8boM |
| linkProvider | Directory of Open Access Journals |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Necrotizing+Soft-Tissue+Infections%3A+A+Retrospective+Review+of+Predictive+Factors+for+Limb+Loss&rft.jtitle=Clinics+in+orthopedic+surgery&rft.au=Park%2C+Hee-Gon&rft.au=Yang%2C+Jong-Heon&rft.au=Park%2C+Byung-Hoon&rft.au=Yi%2C+Hyung-Suk&rft.date=2022-06-01&rft.issn=2005-4408&rft.eissn=2005-4408&rft.volume=14&rft.issue=2&rft.spage=297&rft_id=info:doi/10.4055%2Fcios19166&rft.externalDBID=NO_FULL_TEXT |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=2005-291X&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=2005-291X&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=2005-291X&client=summon |