SOME
COMPLICATIONS OF WOUND INFECTION
· Fistula sinus tracts: often results when abdominal abscesses contiguous to bowel
open to skin. Severe bleeding may occur if there is erosion of major blood
vessels, may be compounded following R.T especially neck to groin.
· Suppressed wound
healing: is a consequence of infection
by the cytokines (proteolysis & collagenase).
· Immunosuppression &
super infection: is a common consequence
of infection of sepsis. Other causes are surgery, trauma or shock. Due to
injury may results into an opportunity for invasion by opportunistic, often
antibiotic resistant organism.
· Other complication
includes:
o Bacteraemia
o Septicaemia
o SIRS
o MODS & MSOD
MANAGEMENT
(Diagnosis & treatment)
Diagnosis
The
aim of management is to detect & treatsepsis before it involves into more
advance stages.
A. Clinical examination: is the simplest & easiest way to detect wound infection
and in infected cases repeated examination is essential, failure to that
progress to complications.
B. Laboratory findings: has limited value but it helps in determining the functions
and effect of the vital organs. Culture from wound infection may give positive
result of organism although in 50% cases results negative. Also culture of
other body fluids should be done routinely based upon clinical features.
Sometimes repeated culture may be required. In about 20% false negative results
may occur.
C. Imaging studies: X-ray has definitive value as in pulmonary infections,
osteomyelitis. MRI for early detection of bone infection abscess in solid organ
by CT scan, USG: partially useful in localizing occult infection. Numerous
radionuclide scans have been tested all with falls results of which 67Ga & 111In are best but rarely
needs.
D. Source of infection: Surgical, traumatic wounds, source from GI tract or urinary
or pulmonary or even sinus infections. Once identified is _____ to surgical
therapy: excision of drainage.
TREATMENT
A. Incission &
drainage: abscess
B. Excission / Amputation: except acute appendicitis, gas gangrene of a limb.
C. Circulatory enhancement: Subcuteneous flap over an infected ulcer due to ischemia.
D. Antimicrobial therapy: Adequate & appropriate antibiotics prevent spread of
infection as well as control the complications.
E. Nutritional support: Malnourished patient remains in catabolic state & can’t
recover well, needs aggressive nutritional therapy.
PROGNOSIS
