Transcript Surgical Infection
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