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 20th
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: tuberculosis, tetanus, gas
gangrene, fungi
Classification
procession:
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
Etiology
Bacteria factors:
adherence
toxins: exotoxin, endotoxin
numbers of bacteria: 105
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 hairfollicle and surrounding tissue
 Pathology: acute suppurative inflammation
 congestion and exudation of components of
blood
Furunculosis: infection of several hair
follicles in a circumscribed area.
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 Streptococci or
Staphylococci aureus
 Clinical presentation: redness of skin,
swilling and boundless
 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