Infections of the subcutaneous tissues may manifest as abscesses, ulcers, and boils. Staphylococcus aureus is the most common etiologic agent of subcutaneous abscesses in healthy individuals. Many subcutaneous abscesses contain mixed bacteria. To a large degree, the organisms isolated from subcutaneous abscesses depend on the site of infection. For example, anaerobes are commonly isolated from abscesses of the perineal, inguinal, and buttock area, whereas nonperineal infections are caused by mixed facultative aerobic organisms.
Chronic undennining ulcer, or Meleney's ulcer, is a slowly progressive infection of the subcutaneous tissue with associated ulceration of portions of the overlying skin. The causative organism is classically a micro-aerobic streptococcus, but anaerobic streptococci and, occasionally, other organisms may be involved.
In many instances, infections of the epidermis and deimis extend and can become subcutaneous infections and even reach the fascia and/or muscle. For example, erysipelas (Figure 60-3) can become a subcutaneous cellulitis and thereafter a streptococcal necrotizing fasciitis. Similarly, folliculitis can readily become a subcutaneous abscess or a carbuncle that can extend to the fascia. Cellulitis also can frequently extend to the subcutaneous tissues (Figure 60-4). Anaerobic cellulitis is
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