View Full Version : Post Operative Wound Infection

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06-08-2008, 08:31 AM
I) Cellulitis:can occur in any of the planes of the abdominal wall.
Superficial cellulites :
1. Unexplained pyrexia.
2. The earliest sign is when the stitches become embedded in the oedematous skin. Later there is a redness extending for a variable distance from the incision or the stitch holes.
3. On palpation, usually one area is found to be more indurated and tender than the remainder. A stitch should be removed from this area. If pus or seropus escapes it should be sent for bacteriological examination;
Ä Treatment: It should then be commenced with a broad-spectrum antibiotic.
Deep cellulitis:
Ä Diagnosis: is characterised by brawny oedema towards one or both flanks, and not infrequently of the scrotum or vulva as well.
Ä Treatment: Antibiotic therapy is the mainline of treatment. When tenderness persists, ultrasonography may localize collection, then, an anatomical incision dividing the muscles carefully, layer by layer, until pus or purulent fluid is encountered is often advisable.
I) Progressive postoperative bacterial synergistic gangrene:
Ä Aetiology: This is, fortunately, a rare complication after laparotomy, usually operations for septic conditions. The condition is due to the synergistic action of aerobic nonhaemolytic streptococci and, usually, a staphylococcus.
Ä Diagnosis: Signs of cellulitis. Within a few hours, a central purplish zone with an outer brilliant red zone can be distinguished and the whole region is extremely tender. The condition advances with various degrees of rapidity. The gangrenous skin liquefies exposing underlying granulation tissue. If the condition persists, overwhelming septicaemia and associated multiorgan failure supervene.
Ä Treatment.Identification of the organisms and a report on their sensitivity to antibiotics is essential. Metronidazole should be given together with a powerful broad-spectrum antibiotic. Without vigorous and effective treatment the gangrene spreads to the flanks and the patient may die of toxaemia. If the infection has become established, surgical debridement of all the necrotic and infected tissue should be performed. Hyperbaric oxygen, if available, can be life-saving.
III) Amoebic Cutis:
Ä Aetiology. It is lethal complication of amoebic colitis, liver abscess or empyema.
Ä Diagnosis. Confirmation may be difficult and an immunofluorescence test necessary.
IV) Subcutaneous gas-forming infection
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