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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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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 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.


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 local inflammation

lymphadenitis 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


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