Wound infections Flashcards
The importance of the infection
The importance of the infection is the delaying of the wound healing
cause of infections
- Mechanically (reducing the vascular supply)
- Increases cellular response
- Bacterial collagenolysis
signs of infection
General signs and local signs
General signs:
- High fever
- Depression
- Decreased appetite
Local signs:
Painful, reddish, heat, swelling, functional limitation
Factors effecting the infections
- Quantity and virulence of the germ
- Patient resistance
Bacterium
Aerob bacterium
Anaerob bacterium
Aerob bacterium
- Staphylococcus
- Streptococcus
- Enterobacterium
- Pseudomonas
Anaerob bacterium
-Clostridium
Types of infections
Bacteriological, clinical, mixed, parasitic, fungal
Clinical infections:
- Presence with local and general signs
- Infected wounds heal slower than uninfected ones
Mixed infections:
-Relatively common, and tissue bacteria numbers above 1 million organisms delays healing
When is fungal infection common?
This infection of superficial wounds is relatively common
-Phythius spp. infection can be catastrophic complications of relatively triviale wounds
Which complications can we have in an infection?
Foreign body, necrotic tissue, blooding, burns, Loss of blood supply
Other factors making the infection worse:
- High concentration desinfitiation – stop the healing
- Bone sequester – bigger infection
- Sutures material
- Talcum
- Metal implants
Antiseptics:
- Povidone-iodine (0.1 – 0.2%)
- Chlorhexidine (0.05%)
- Hydrogen peroxide (3%)
- Acetic acid solution (0.25 – 0.5% not recommended)
Infections:
- Primary infection
- Secondary infection
- Exogen (contact, aerogenic) – most common
- Endogen (haematogen)
View of the infection:
- Primary infection
- Secondary infection
- Exogen (contact, aerogenic) – most common
- Endogen (haematogen)
Clean infection:
- Non traumatic surgical wounds
- Hollow viscus is not entered
- Incision does not pass through infected or nonviable tissue
Clean - contaminated:
-Surgical wounds in which the lumen of the alimentary, urogenital or respiratory tract may be entered but with minimal invasiveness and contamination
Contaminated infection:
- Traumatic wounds
- Relatively clean source of wounding
- Commonly accompanied by inflammation
- Include surgical wounds that contain “spill” from another organ and traumatic wounds older than 4 to 6 hours
Infected wounds
- Old traumatic wounds
- Pus and/or abscess is present
- Preoperative entry into viscera may have occurred
- Infected wound
Which calassification can we put the wounds into after bacterium?
- Pyogenic
- Putrid
- Aerogenic
- Mono- or polyinfection
Pyogenic wound infection:
- Staphylococcus
- Streptococcus, Rhodococcus
- Corynebacterium
- Pseudomonas
- E. coli
- 6 – 8 hours after wounding we will have the pyogenic infection
- Endo- and exotoxins will be produced, signs:
- Thrombotisation of vessels
- Necrosis and neutrophils
- Leukocytosis
Signs of pyogenic wound infections:
Local:Painful, reddish, heat, swelling, functional limitation, lymphadenitis
general:
Fever, decreased appetite,
Local signs of pyogenic sutured wound:
- Swelling, tension of the material and tissue, fluctuation, discharge of pus
- Painful, redish, functional limitation
- We do the opening of the edges and demarcation, second intention
- Bacto test to check resistance
- Ther.: AB, opening when fluctuate drainage and bandage
Local signs of pyogenic fresh wound:
- Discharge of pus, swlling
- Painful, reddish, functional limitation
- Demarcation
- Ther.: AB, helping in the cleansing (?)
Special clinical forms of pyogenic wound infections:
- Erysipelas
- Phlegmone
- Abscess
Erysipellas:
- Pyogenic germs specially streptococci in the skin
- Fastly progrediated and demarcated
- Horse, cow, pig and dog
- Pustule, phlegmone and gangrene
-Thr.: AB, sulfonamides (recidivate)
Phelgmone
- Septic or aseptic inflammation of the connective tissue
- It can be subcutan, subfascial, intermuscular,
- Special form I horse: Einschuss-phlegmone in horse
- Localized or diffuse
Subcutan signs of phlegmone:
- Painful
- Swelling is sharply described and daughy
- Functional limitation
- Fever
Subfascial and intermuscular signs of phlegmone:
Most painful (skin over the swelling is moveable) -Swelling is smooth and tight -Strong functional limitation -Fever
Therapy: AB, rest, hyperaemisa bandage , ointment, NSAIDs
Phlegmones can become:
- Sanatio
- Abscess
- Elephanthiasis
Abscess:
- Cavity in the tissue filled with pus
- Empyema: pus in a natural body cavity
- Sequester: abscess in the bone
- Result of haematoma, seroma, phlegmone or foreign body infection
- Demarcated inflammation and necrotic tissue
Injury of the eye:
Septic endothalmitis
Cause of the abscess:
- Wrong deinfitiation of the skin
- Non sterile needle, instruments
- High concentration of antiseptic fluids
- Phlegmone
- Necrotic tissues
- Foreign body
Signs of abcess:
- Well focused, fluctuating, painful, swelling
- Centhesis
what can happen to the abscess?
-Absoption
-Opened
-Fistulation
Thr.: open it, curettage
What is pus?
-Serum and necrotic tissue part with dead leucocytes and bacteria
Results of pyogenic infections:
- Toxaemis
- Septicaemia
- Pyemia
- Local result - Fistulation (bursitis)
Gasphlegmone
-Clostridium
-Manifestation of signs (1 – 4 hours)
-Toxins
-Emphysematous gas production
-Severe signs
Thr.: surgical approuche
tetanus:
- Clostridium tetani toxins in punctured deep wound or after surgical procedures (castration 10 – 14 days)
- Mainly in horse, cow or in pig
Signs of tetanus:
Muscle rigidity, as max opened nostrils, prolapse of the membrane nicitans, trismus, rigid posture and moving and ear holding, dyspnoe, defense of the abdominal
