Diabetul zaharat este cea mai frecventa afectiune metabolica a patologiei umane, cu o prevalenta in crestere.

Datorita caracterului particular al infectiilor la pacientul diabetic, cu evolutie rapida (datorata deficientei
mecanismelor imune de aparare, hipoxiei secundare microangiopatiei) spre extensie locala, dezechilibru
metabolic, cu soc septic si deces, este importanta recunoasterea posibilitatii unei infectii de parti moi in stadiu
precoce la pacientul diabetic, cu instituirea unei terapii adecvate pentru reducerea morbiditatii si mortalitatii, cu
posibil prognostic favorabil. Diagnosticul infectiilor de parti moi in unele cazuri este dificil de stabilit, de cele mai
multe ori semnele locale fiind absente complet sau partial, expresia tegumentara fiind minima, in contradictie cu
extensia in profunzime. Dezechilibrul metabolic refractar la tratament de cele mai multe ori este expresia unei
infectii profunde de parti moi. Tratamentul infectiilor de parti moi consta in interventia chirurgicala de urgenta cu
excizia completa a tesuturilor devitalizate si necrozate (descoperirea intraoperatorie a fuzeelor si debridarea
agresiva este critica in evolutia pacientilor), cu tratament antibiotic si reechilibrare metabolica.

Aceasta lucrare isi propune sa expuna cateva cazuri prezentate cu imagini edificatoare ale experientei spitalului
nostru in care expresia locala este minima comparativ cu gravitatea infectiei si a dezechilibrului metabolic.

Infectiile de parti moi la pacientul diabetic nu se intalnesc frecvent in activitatea medicala, insa chiar in cazurile in
care se intervine de urgenta chirurgical si medicamentos,acestea constituie o patologie cu evolutie imprevizibila,
cu prognostic rezervat, spitalizare de lunga durata si mare consumatoare de resurse intraspitalicesti, acest lucru
facand ca majoritatea spitalelor sa nu isi doreasca acesti pacienti.

Diabetes is the most common metabolic disorder of the human pathology with an increasing prevalence. Due to
the particular infection in the diabetic patient with rapidly evolving (due to deficiency mechanisms of immune
defense, hypoxia secondary microangiopathy) to local extension, metabolic imbalance, septic shock and death, it is
important to recognize the possibility of infection of soft tissue early-stage diabetic patient, the setting of
appropriate therapies to reduce morbidity and mortality, with possible favorable prognosis. The diagnosis of soft
tissue infections in some cases is difficult to determine, most often local signs are completely or partially absent
expression of skin is minimal, contradicting extension in depth. Metabolic imbalance refractory to treatment often
is the expression of a deep soft tissue infection. Treatment of soft tissue infections consists in emergency surgery
with complete excision of devitalized tissue and necrotic (intraoperative discovery of expansion and aggressive
debridement is critical in the evolution of patients) with antibiotic therapy and metabolic rebalancing.

This paper aims to expose several cases presented with images edifying experience of our hospital that local
expression is minimal compared to the seriousness of the infection and metabolic imbalance.

Infections of soft tissues in the diabetic patient is not frequently found in medical work, but even in cases where
urgent action surgical and medication, they constitute a pathology evolving unpredictable, reserved prognosis,
long hospitalization and expensive material resources of hospital acquired, so the most of the hospitals do not
want these patients.