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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.

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Surgical Infection

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  1. Surgical Infection

  2. 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%.

  3. 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.

  4. 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.

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

  6. Classification procession: acute subacute chronic

  7. Classification Source of pathogens: Primary Secondary Exogenous Endogenous

  8. Classification Opportunity: Opportunistic Superinfection Nosocomial infection

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

  10. Etiology Bacteria factors: adherence toxins: exotoxin, endotoxin numbers of bacteria: 105

  11. Etiology Local factors: injury of skin or mucosa duct obstruction blood supply skin or mucosa diseases

  12. Etiology Systemic factors: • severe disease • hormone • malnutrition • AIDS

  13. 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.

  14. Pathology • results: alleviate suppurative to spread to be chronic

  15. Pathology • Specific infection: tuberculosis tetanus gas gangrene fungi infection

  16. Diagnosis • Clinical presentation: systemic condition local condition organic-systemic dysfunction specific expression • Investigation: experiment test imaging: US, X-ray,CT, MRI

  17. Management • Local treatment: • protect infection site • superficial lesion • deep lesion • Antibiotics:

  18. Management • Improve systemic conditions: hydro-electrolyte, nutrition companion diseases

  19. Superficial soft tissue suppurative infection

  20. 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 several hair follicles in a circumscribed area.

  21. Furunculoisis

  22. 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.

  23. 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

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

  25. 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.

  26. Treatment • Incision and drainage • Antibiotics

  27. Acute suppurative infection of the hand

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

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

  30. 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

  31. thenar space midpalmer space hypothenar space • Treatment incision irrigation and drainage antibiotics

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