Surgical InfectionSurgical Infection

HistoryHistory

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%.

HistoryHistory

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.

DefinitionDefinition

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: Classification:

Pathogenesis:

Non-specific infection: suppurative infection

presentation: redness, swelling, hot, soreness

pathogens: Staphylococci aureus, Streptococci.

 

Specific infection: tuberculosis, tetanus, gas gangrene, fungi

ClassificationClassification

procession:

acute

subacute

chronic

ClassificationClassification

Source of pathogens:

Primary

Secondary

Exogenous

Endogenous

ClassificationClassification

Opportunity:

Opportunistic

Superinfection

Nosocomial infection

EtiologyEtiology

Causes of surgical infection:

normal bacterial flora---pathogenic bacteria

exogenous bacteria

low host resistance

EtiologyEtiology

Bacteria factors:

 

adherence

toxins: exotoxin, endotoxin

numbers of bacteria: 105

EtiologyEtiology

Local factors:

injury of skin or mucosa

duct obstruction

blood supply

skin or mucosa diseases

EtiologyEtiology

Systemic factors:severe diseasehormonemalnutritionAIDS

PathologyPathology 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.

PathologyPathology

results:

alleviate

suppurative

to spread

to be chronic

PathologyPathology

Specific infection:

tuberculosis

tetanus

gas gangrene

fungi infection

DiagnosisDiagnosis Clinical presentation:

systemic condition

local condition

organic-systemic dysfunction

specific expression Investigation:

experiment test

imaging: US, X-ray,CT, MRI

ManagementManagement

Local treatment:protect infection sitesuperficial lesiondeep lesionAntibiotics:

ManagementManagement

Improve systemic conditions:

hydro-electrolyte,

nutrition

companion diseases

Superficial soft tissue Superficial soft tissue suppurative infectionsuppurative infection

FuruncleFuruncle

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

CarbuncleCarbuncle

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.

CellulitesCellulites acute infection of loosing connective tissue.Pathogens: B-hemolytic Streptococci or

Staphylococci aureusClinical presentation: redness of skin,

swilling and boundlessAnaerobic cellulites: crepitationTreatment: antibiotics

incision and draninage

ErysipelasErysipelas

Skin wound local inflammation

lymphadenitis systemic inflammation

Redness of skin with clear boundary

Edema of proximal lymphanode

Systemic sepsis

AbscessAbscess

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.

TreatmentTreatment

Incision and drainage

Antibiotics

Acute suppurative infection Acute suppurative infection of the hand of the hand

paronychiaparonychia

lateral nail fold trauma redness, pain

suppurative infection

Treatment: incision and drainage removal of the nail: infection extend

deep to the nail antibiotics

felonfelon

paronychia spread or penetration wound

pain

fever

WBC

Treatment: incision and drainage

antibiotics

Suppurative tenovaginitis, bursitis Suppurative tenovaginitis, bursitis and infection of palm spacesand 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