Revision

AHMED EISSA

MSA UNIVERSITY
Q1: Define
 Definitions
• The invasion of a microorganism into the host tissues
Infection
causing host to be diseased

• The presence of replicating micro-organism in the

Colonization
wound without wound damage

• Presence of non-replicating micro-organism in the

Contamination
wound

• An infection that occurs after surgery in the part of the

Surgical site infection (SSI) body where the surgery took place (within less than 30
days of surgery)

• An infection acquired in the hospital by a patient who

Hospital acquired infections (HAIs)
was admitted for a reason other than the infection
Definitions

• Excessive collagen formation; in hypertrophic scars it is

Hypertrophic scar limited to the margins of the original lesions

• Excessive collagen formation; in keloids it extends

Keloid beyond the margins of the wound and invades healthy
skin
 Wound Healing
Scar
formation Regeneration
A mechanism of repair
resulting in the formation The process through
of a scar, an aspecific which the normal
connective tissue that architecture of an organ
replaces the injured tissue or tissue is reproduced
as a “patch” to ensure the
maintenance of tissues’
homeostasis.

Predominant in cutaneous
wounds Predominant in fetal wounds
Q2: Stages of wound
healing
 Hemostasis
• Starts immediately after injury and lasts for few
minutes
• It aims to stop bleeding
• Mechanism: Vasoconstriction; platelet
aggregation; release of pro-inflammatory
cytokines
 Inflammation
• Starts 24-48 hours after injury and lasts for 3-7 days
• It aims to clean the wound
• Mechanism: Neutrophils are responsible for clearance
of microbes and cellular debris; Macrophages release
cytokines to promote the inflammatory response
besides its role to clear apoptic cells (including
neutrophils)
 Proliferation
• Starts 48-72 hours after injury and lasts for 7-15
days
• It aims to restore tissue function and structure
• Mechanism: Re-epithelization; angiogenesis;
collagen synthesis; extra-cellular matrix
formation.
 Remodelling

• Starts 15-21 days after injury and may last

for 6-12 months
• It aims at maturation of granulation tissue
into scar
• Mechanism: wound contraction; collagen
deposition.
Q3: Types of wound
healing
Surgical wound healing process

Primary • Normal healing process

Secondary • Through granulation and epithelization

in open wounds

Tertiary • Graft or flap is needed

Q4: Risk Factors of
wound infection
Risk factors of Wounds infection

Patients’-related risk factors

• Individual characters (age, sex, obesity, and hygene)
• Life style (smoking & alcohol)
• Comorbidities (diabetes, heart diseases, and renal
insufficiency)
• Medications (immunosuppressants)
• History (prior chemo or radiotherapy)
Risk factors of Wounds infection

Surgery-related risk factors

• Type of surgery
• Elective or emergency
• Blood loss/ transfusion
• Medical device implant
• Surgery duration
• Case complexity
• Surgeon’s experience
• Forgien body
Risk factors of Wounds infection

Anesthesia-related risk factors

• Tissue perfusion
• Normovolemia / hypovolemia (venous insufficiency)
• Oxygen saturation
Q5: Why do we use
sutures?
 Why Sutures?
• To promote contact between the edges of the wound to
achieve rapid healing.
• To give the wound resistance to tension.
• To limit residual dead spaces between the margins of the
wound.
• To prevent complications, i.e., infection, hemorrhage, and
tissue necrosis.
• To preserve the normal contour and shape of tissue.
Q6: classification
sutures?
 Classification of suture materials (origin)

NATURAL
These are sutures
manufactured from raw
materials of natural origin
(vegetable or animal), e.g., silk
and catgut.
SYNTHETIC
These are sutures produced from
polymerization of molecules or
compounds of chemical origin.
Classification (absorbability)
 Classification of suture materials (number of
threads)

Braided Monofilament
they are sutures composed of They are sutures made up of a
several thinly wound single monofilament that makes
monofilaments around a them compose the structure.
central core (GRAINED) or
twisted around themselves
(PORTS).

• Less infection
• Easier to handle, tie, & • Less traumatic
knot
 Q7: most common
caustive organism of
surgical site infections?
Pathophysiology of SSI
Staphylococcus Aureus 20%
Coagulase-negative Staph. 14%
Enterococci 12%
E. coli 8%
Pseudomonas aeruginosa 8%
Q8: classification of
wounds?
 Classification of Wounds

Class Description Infective risk (%)

Class I (Clean) • Uninfected operative wound <2%
• No acute inflammation
• Primary closure
• Respiratory, GIT, urinary, biliary tracts are
not entered
• No break in aseptic techniques
• Closed drainage system (if needed)
• Example (Hernia)
 Classification of Wounds

Class Description Infective risk (%)

Class II (Clean- • No evidence of infection or major break <10%
contaminated) of aseptic technique
• Elective entery into respiratory, GIT,
urinary, biliary tracts with minimal
spillage
• Example (appendectomy or
hysterectomy)
 Classification of Wounds

Class Description Infective risk (%)

Class III • Non-purluent inflammation 20%
(Contaminated) • Gross spillage from GIT
• Penetrating traumatic wound <4 hours
• Major break in aseptic technique
• Example (urgent bowel resection)
 Classification of Wounds

Class Description Infective risk (%)

Class IV (Dirty- • Purluent inflammation 40%
infected) • Preoperative perforation of viscera
• Penetrating traumatic wound >4 hours
• Example (intestinal fistula)
Q9: Measures to prevent
surgical site infection?
 Preventing SSI
Mechanical bowel
Discontinuation of
Enhanced nutritional preparation +
immunosuppressant
support (nutritional Preoperative bathing prophylactic Abs in
should be based on
formula) patients undergoing
individual condition
colorectal surgeries

Preoperative AB
Hair should not be
(within 120 minutes
removed or if Proper sterilization of Proper sterilization of
before surgery,
necessary, use a the surgeon the surgical site
considering AB half-
clipper not a shaver
life)

Prophylactic wound
Antibacterial coated
irrigation with or Laminar air flow
sutures
without antiseptic
 Preventing SSI

Keep Hemoglobin Stop smoking 30

A1C levels below 7% days before
& serum glucose <200 surgery

Careful and Maintian

gentle handling intraoperative
of tissues normothermia
Q10: Discuss cellulitis?
 Wound Infection

1) Cellulitis
• When a wound (break in the skin) occurs, it allow the entery of
pathogens to the subcutaneous tissue causing acute superficial
infection
• Caustive organism: Streptococcus pyogenes
• Presentation: erythema, warmth, edema, & tenderness
 Wound Infection

1) Cellulitis
• TTT of Mild Cellulitis: Antibiotics covering Streptococcal
species (for a minimum of 5 days)

• TTT of purleunt cellulitis (MRSA): IV antibiotics with sulfa

• Hospitalization: indicated in patients with MRSA or patients

showing signs of systemic infection

• If untreated: Bacteremia
Q11: Discuss Necrotizing
fasciitis?
 Wound Infection

3) Necrotizing Fasciitis
• Infection of the soft tissue, which start in the superficial fascia
and progresses rapidly to the deep fascia resulting in occlusion
of the small blood vessels that supply the overlying skin and
subsequently skin necrosis

• If untreated ----- systmeic inflammatory response syndrome &

spetic shock
 Wound Infection

3) Necrotizing Fasciitis (etiology)

Surgical wounds
Trauma accounts
accounts for 4.3%
for 26.1% of NF
of NF
Wound Infection

3) Necrotizing Fasciitis (risk)

Peripheral vascular
Diabetes mellitus
disease
 Wound Infection

3) Necrotizing Fasciitis (presentation)

Pain Fever

Skin manifestation (Erythema,

tenderness, swelling, blisters or bullae,
necrosis)
 Wound Infection

3) Necrotizing Fasciitis (Treatment)

Surgical Broad spectrum
debridment AB

Hyperbaric
Fluid resuscitation
oxygen / IV
& wound care
immunoglobulin
 Q12: Discuss
pathophysiology &
Treatment of Gas
gangrene?
 Wound Infection

4) Gas Gangrene (Pathophysiology)

Clostriduim species (gas producing organism)
produce alpha & theta toxins that cause
extensive damage to the tissues
Wound Infection

4) Gas Gangrene (Treatment)

1- Surgical debridement & Fasciotomy
2- Aggressive ABs
3- IV fluid resuscitation
4- ICU monitoring
5- Hyperbaric oxygen therapy
Thank you