Surgical Infection

History

 Lister: 1867 On the antiseptic principle in practice of surgery  Louis Pasteur, Ignaz Semmelweis, Theodor Kocher and William S. Halsted  Application of antiseptic practices allowed infection rate of operation to drop from 90% to 10%.

History

 Antibiotics: introduced in the middle of 20 th century  Hope serious surgical infection eliminated, but this did not occur.

 Nosocomial infection, widespread antibiotics therapy  New techniques: endoprosthesis, transplantation requires immunosuppressive agents, et al.

Definition

The infection required operative intervention, including that complicated from trauma, operation and burns, et al.

Caused by the invasion, resident and proliferation of pathogens, such as bacteria, viruses and fungi et al.

Classification:

Pathogenesis : Non-specific infection: suppurative infection presentation: redness, swelling, hot, soreness pathogens: Staphylococci aureus, Streptococci. Specific infection: gangrene, fungi tuberculosis, tetanus, gas

procession:

Classification

acute subacute chronic

Classification

Source of pathogens:

Primary Secondary Exogenous Endogenous

Classification

Opportunity:

Opportunistic Superinfection Nosocomial infection

Etiology

Causes of surgical infection: normal bacterial flora---pathogenic bacteria exogenous bacteria low host resistance

Bacteria factors:

Etiology

adherence toxins: exotoxin, endotoxin numbers of bacteria: 10 5

Etiology

Local factors:

injury of skin or mucosa duct obstruction blood supply skin or mucosa diseases

Etiology

Systemic factors:

 severe disease  hormone  malnutrition  AIDS

Pathology



Non-specific infection:

 bacteria proliferation  leucocyte infiltration  inflammatory media and cytokines release  congestion, excudation  accumulation of serum, blood cells, necrotic tissues  redness, swelling, hot and soreness, and dysfunction.

Pathology



results:

alleviate suppurative to spread to be chronic

Pathology



Specific infection:

tuberculosis tetanus gas gangrene fungi infection

Diagnosis



Clinical presentation:

systemic condition local condition organic-systemic dysfunction specific expression 

Investigation:

experiment test imaging: US, X-ray,CT, MRI

Management



Local treatment:

 protect infection site  superficial lesion  deep lesion 

Antibiotics :

Management



Improve systemic conditions:

hydro-electrolyte, nutrition companion diseases

Superficial soft tissue suppurative infection

Furuncle

 Acute suppurative infection within one hair follicle and surrounding tissue  Pathology: acute suppurative inflammation  congestion and exudation of components of blood Furunculosis: infection of follicles in a circumscribed area.

several hair

Furunculoisis

Carbuncle

 A confluent infection involving multiple contiguous follicles in which the infection is limited to the subcutaneous tissue by thick overlying skin and dense subcutaneous fascia.

 Carbuncles require incision for drainage and treatment.

Cellulites

 acute infection of loosing connective tissue.

 Pathogens:

B-hemolytic Staphylococci aureus

 Clinical presentation: swilling and boundless

Streptococci

redness of or skin,  Anaerobic cellulites: crepitation  Treatment: antibiotics incision and draninage

Erysipelas

Skin wound lymphadenitis local inflammation systemic inflammation Redness of skin with clear boundary Edema of proximal lymphanode Systemic sepsis

Abscess

 Characterized by a necrotic center without a blood supply and composed of debris from local tissues, dead and dying leukocytes, components of blood and plasma and bacteria  This semiliquid central portion (Pus) is surrounded by a vascularized zone of inflammatory tissue.

Treatment

  Incision and drainage Antibiotics

Acute suppurative infection of the hand

paronychia

lateral nail fold trauma redness, pain suppurative infection Treatment:  incision and drainage  removal of the nail: infection extend deep to the nail  antibiotics

felon

paronychia spread or penetration wound pain fever WBC Treatment: incision and drainage antibiotics

Suppurative tenovaginitis, bursitis and infection of palm spaces

infection of the flexor tendon sheath, bursts and palm spaces, which is usually caused by a puncture wound to the volar aspect of the digit or palm

thenar space midpalmer space hypothenar space 

Treatment

incision irrigation and drainage antibiotics