Download Human body`s factors tending to suffer from surgical infection

Teaching Plan of Xinjiang Medical University
Surgical Infection
(Compiling Time: In Junuary 22 2009.Stating Using :In March, 9，2009)
Ma Shaolin
Teaching Objective
To learn the concept ,classification, cause of disease, prevention
principles of management of surgical infection.
Teaching Requirement
1.To aster the concept,classification,cause of disease,prevention,clinical
manifestitation,diagnosis of the surgical infection.
2.To master the local and systemic principles of management of surgical
infection.
3.To being familiar with the diagnosis and the the principles of
management of the pyogenic infection of superficial tissues and
hands.
4.To aster the concept,cause of disease ， diagnosis ， principles of
management of the septicopyemia.
5.To
master
the
cause
of
disease,
pathologic
changes,clinical
manifestitation, prevention, principles of management of the specific
1
surgical infection(Tetanus,Gas Gangrene).
6.To understand the common pathogens, clinical manifestitation,
diagnosis, principles of management of the systemic surgical
infection.
Teaching Contents
1.The
concept,classification,cause
of
disease,prevention,clinical
manifestitation,diagnosis of the surgical infection.
2.The local and systemic principles of management of surgical infection.
3.The diagnosis and the the principles of management of the pyogenic
infection
of superficial tissues and hands.
4. The concept,cause of disease，diagnosis，principles of management
ofThe septicopyemia.
5.The cause of disease, pathologic changes,clinical manifestitation,
prevention, principles of management of the specific surgical
infection(Tetanus,Gas Gangrene).
6.The common pathogens, clinical manifestitation, diagnosis,
principles of management of the systemic surgical infection.
As
are
four
we
know,
basic
bleeding,
key subjects
infection,
in
2
the
pain, and
development
anesthesia
of
surgery
for
many
them
years.
Certainly
everyday.
surgeon , he
If
speaking,
someone
surgeons
want
to
must solve these problems
must
be
a
face
excellent
correctly.
Concept of Surgical Infection
A surgical
respond
infection is an infection that ( 1 ) is unlikely to
to
nonsurgical
treatment
and
occupies an
unvascularized space in tissue ( which usually must
or incised and
drained )
Common
examples of
empyema,
gas
regrettable
familiar
injury
infection,
reoperation,
One
of
when
with
/
physiological
first
and
vicious
arts
how
to
surport,
of
the most
important
circle
and
surgery
intervene
antibiotic
therapy. For infections arising in
far
are
the
is
to
with
therapy,
Surgeons
of
operation
organ
further
know
of treatment
Contagion
……
传染
infection.
where
3
/
drainage,
and
nutritional
is
to
We should know the meaning of the words :
污染
or
excision,
surgical drainage.
……
are
failure,
a space or in dead tissue,
aspect
Pollution
site.
appendicitis,
immunosuppression,
malnutrition,
fine
group
most abscesses.
the
malnutrition,
further
the
( 2 ) occurs in an operated
the
gangrene,
be excised
by
establish
……
Infection
If
someone
感染
has
been
which Pathogenic
microorganisms
to
infectious
suffer
from
polluted
by
contaminent
in
may exist , he is not sure
disease
and
only
to
be
a
condition of pollution.
Classification of Surgical Infection
①
According
pathogen,
kinds
we
as
specific
surgical
illness
is
specific
surgical
suffers
from
mycotic
infection
it
specific
surgical
bone
tetanus.
illness
and
a
doctor
a
surgical
the
disease.
happens
For
nonspecific
into
two
are
diseases
the
are
infection,
If
a
doctor
surgical
4
diagnoses
the
if
someone
certain
that the
wound
by
called
tuberculosis.
the
caused
is
caursing
example,
we
on
mycotic
contrary,
of
infectious disease,
pathogen
Mycobacterium
infectious
the
If
tuberculosis,
by
joint ),
Second
know
is definitely
On
as
to
infection
infection;
specific
infectious
is caused
patient,
a
characteristics
one is called nonspecific surgical
infection.
sure
disease
and
surgical
surgical
as
bone
the
First
pyogenic
doctorr
kinds
classify
or
somenoe’s
the
can
the
following:
infection
the
to
of
fungus.
tuberculosis
gas
a
a
burn
Common
( esp
in
gangrene and
diagnoses
infectious
If
somenoe’s
disease,
the
doctor
is
not
nonspecific
child
surgical
suffers
his
sure
illness
know
infectious
from
as
to
acute
a
the pathogen
disease.
abdomen
For
and
appendicitis,
but
caursing the
example,
we
have
we
are
if a
diagnosed
not
certain
what exact pathogen causes his acute appendicitis. There are
many
examples
furuncle
or
cellulitis,
of
nonspecific
furunculosis,
acute
cholecystitis,
surgical
infectious
carbuncle,
acute
or chronic appendicitis,
diseases:
or
chronic
acute or chronic
acute or chronic peritonitis,
lymphnoditis
or
lymphangitis (eg.erysipelas) ……etc.
②
According
classify
acute
the
to
the course of surgical infection
surgical
surgical
infection
infection,
into
three
chronic
kinds
surgical
as
we can
following:
infection
and
sub-acute surgical infection.
Acute Surgical
The
signs
quickly,
the
disease
dose
acute
and
Infection
symptoms
of
pathological
not
last
appendicitis
surgical
and
beyond
typically
clinical
three
runs
a
infection
process
weeks.
short
For
settle
of
the
example,
course
from a
few hours to about 3 days.
Chronic Surgical Infection
The
signs
and
symptoms
5
of
surgical
infection
exist
beyond
two
month.
a chronic absess
Chronic
acute
surgical
surgical
For
example,
could continue to exist for a long time.
infection
could
infection
chronic surgical
the signs and symptoms of
could
become
be
acute
attack
persistent
to
and
become
infection.
Sub-Acute Surgical Infection
The
pathological
between
and
clinical
3 weeks and
process
of
the
disease last
2 month.
Meaning:
Acute
Surgical
should
be
Infection
treated
as
is
a
quickly
surgical
as
emergency
possible,
which
otherwise, the
illness will be delayied.
③other classifications
Primary surgical
infection
Secondary surgical infection
subphrenic
abscess, pelvic abscess
Mixed surgical infection
Ectogenous surgical
infection--pathogens coming from outside of
human body /envirument /body surface
Endogenous
surgical
internal parts
Nosocomial
infection
infection—pathogens
from
of human body--intestinal cavity / mouth cavity
/ hospital surgical infection:
is
coming
infection
that
6
occurs
Noscomially acquired
48
hours after
hospitalization.
through
Patients may
contact
with
personnel
environment, or
infection
harbored
the
by
nosocomially
human
hospital,
should
In
rules
be
frequent
may
patient
acquired
contact.
acquired infection in hospital
made
obeyed.
before
are
to
Unwashed
minimize
hand
and
washing
even
is
the
single most
preventing
nosocomial
should
a
be
atmosphere,
patient
matter
failure
contacts
unethical
in
by
infections.
through
and
such
sepsis,
Routine
Therefore,
procedure
for
hand washing
of
reflex
conditioning.
to
wash
one’s
a
hospital
is
as
burn wound
colitis.
important
hygine
far the most
infections
pseudomembranous
Most
transmission in
dress,
hands
nosocomial
bacteria
transmitted
pneumonia, Intravenous catheter-related
infection,
from
operation.
for behavior,
source of
from nonsteril
developed
bacteria
order
or
In today’s
hands
between
essentially
an
act.
Pathogenic microorganisms of Surgical Infection
Bacterium
infections.
is
Others
the
most
can
Mycoplasma， Rickettsia
common
cause
Fungus ，
be
etc.
7
of
Virus ，
the
surgical
Parasite ，
Bacteria of particular surgical
①staphylococci
main
are
pathogenic
pustules,
Gram-positive
species
boils,
importance
organisms
is S. aureus.
bresst
This
abscesses,
production
include
of
a
variety
coagulase
of
which
In
sensitive
the
early
to
the
promotes
the
produces
and
is due
toxins;
clotting
to
these
of plasma,
activity.
antibiotic
common
typically
S. aureus
enzymes
erecting a barrier to neutrophil
which
wound infections and
osteomyelitis. Part of the virulence of
its
of
era,
antibiotic
most staphylococci were
including
penicillin.
Now
more than 85％ of strains in both family and hospital are
resistant.
This
penicillinase.
reasonable
is
Most
range
(氟氯西林),
of
are
streptococci
can
the
cause
spreading
facilitated
In
limb
strains
and
ability
remain
some
of first
of
choice
Gram-positive
of
acute
to
produce
sensitive
to
of
organisms
the
a
draning
For
is vancomycin.
Beta
haemolytic
Streptococci.pyogenes
which
dermis
hyaluronidase
8
cephalosporins.
organism.
cellulitis
involving
production
infection,
their
produce haemolysis.
infection
by
to
commonly used antibiotics, e.g. flucloxacillin
the drug
②streptococci
due
S.aureus
erythromycin
staphylococci ,
usual
largely
is
and
and
towards
a
is
locally
hypodermis,
streptokinase.
reginal
lymphy
nodes
via
inflammation
lymphatics
and
lymphangitis.
enlarged,
painful
The
may
red
regional
painful
produce
streaks
along
nodes react
and
tender,
the
drug
a
perilymphatic
the
limb,
i.e.
vigorously, becoming
condition
known
as
lymphadenitis.
Penicillin
infection.
given
is
In
seriously
parenterally.
responsible
with
ill
patients,
other
many
surgical
bacteria.
generation
is
extended-penicillin,
e.g.
streptococcal
penicillin
is
also
sensitive
to
/ cephalosporins.
Gram-negative
infections,
Colibacillus
cephalosporins,
in
benzyl
are
/ erythromycin
/ Bacillus coli
for
choice
Streptococci
ampicillin / amoxicillin
③colibacillus
of
is
e.g.
ticarcillin.
bacilli
often
in
sensitive
synergy
to
cefotaxime
Gentamicin
and
third
and
is still a very
effective and cheap against coliforms.
④Bacillus
pyocyaneus
⑤Bacillus
proteus
Pathogenesis of Surgical Infection
Among
planet,
only
the
vast
diversity
of
microscopic
a
small
subset
is
believed to be capable of
infecting
the
human body
only
of
30-40
7
extant
and
causing disease.
bacterial
9
divisions
life
on this
For example,
on the earth
contains
members
that
are
recognized
pathogens
in
humans.
Microorganisms
human
body
variety
of
are
could
widely
be
contaminated
microorganisms
everytime
infections
is
not
certain
to
conditions
of
human
body,
for
many
defense
individuals
despite
countless
microorganisms.
with
microbial
remains
free
of
viewed
as
which
microorganisms
environment
destruction
host’s
and
of
replicate,
the
nutrients.
tissues,
Microorganisms
skin
as
and
contains
have
evolved
soma,
this
relative
long-term
coexistence
are
with
at equilibrium
rich
in
nutrients,
Diseases
can
equilibrium,
be
in
the human body from the
well
the
inflammation
as
rapid
depletion
and
of
the
expantion of the
leads to the death of the host.
could
mucous
a
the
body
people
be
found
variety
on
the
membrane ( e.g. oral
cavity、 alimentary tract )。 The internal
body
but
normal
causing
Unchecked,
microbial population
human
invade
also by a
the
the
from
and
in
microorganisms.
away
nature
everywhere,
their
internal
replicating
progression
ensure
Healthy
world;
or
in
polluted
human
that
of
/
happen
mechanisms
survival
the
scattered
of
10
surfaces
cavity、 nasal
enviroument
microorganisms
of
of human
which
are
acquired
throughout
equilibrium
with
they
not
do
Instead,
they
infection
from
exist
the
Again these organisms achieve
human
body.
replicate,
without
in
nor
a
replication
consumed
by
process
the
do
When
to
is
produece
a
and
is
progression away
is disturbed,
nutrients
population
toxins.
which
balance
host
disease
condition
latent state,
the
begins,
these
they
Disease
proliferating
leads
Under
dormant or
disease.
equilibrium.
microbial
This
the
life.
of
are
then
microorganisms.
ultimate
death
unless
microbial replication is blocked.
Happening
on
the
of
infection
microorganisms
but also human
first
we
should
easy
to
cause
should
which
is
be
depended
able
to
not
cause
only
infection
bodies which is easy to be infected . At
answer:
the
What
surgical
kinds
of
microorganisms are
infection?
What
kinds
of
human bodies are easy to be infected ?
Pathogenic factors of pathogen
①Adherence
factor ( adhesion )
Attachment
to host
for
most
pathogens.
a
host
cell
attachment
system
often
to
substrates
Those
is
early
organisms
rely
on
ensure
that
redundant
continued
11
and
critical
remain
step
outside
complementary
colonization
of
the
host. In
some cases,
( ie .adhesion)
cause
the
along
expression
confers
disease.
on
of an attachment factor
a microbe
Microbial
the
adherence
is
ability
to
critical
for
microbe-microbe interaction and the formation of biofilms.
②Toxins
Host
cell
mechanisms
host
associated
cellular
break
with
defense,
down
transmission.
entirely
intoxincation
is
one
microbial
elicit
or
virulence.
nutrients,
facilitate
microbial
and
In
extreme
cases,
to
the
blocks
microbial
barriers,
ascribed
Toxin
create
anatomic
some
the oldest-known
action
virulence
of
a
can be
secreted toxin;
examples include diphtheria and tetanus.
Tetanus:
grow
After
trauma---- Clostridium.tetani
and reproduce
in
the wound,
----exotoxin ( tetanospasmin )
system ---- continuous
steletal
muscles
antitoxin,
to prevent
should
be
active
vaccine
enter
contraction
tetanus,
all
and
of
1500u
with
produce
blood
of body---toxemia,
injected
wound ,
exotoxins
flow / circulatory
clonic
spasm
of
all
not bacteremia----tetanus
patients
TAT
with
trauma
as
passive
therapy .to treat tetanus, 1500u TAT should be x 10.
immunization
as
then
enter
immunotherapy ,
diphtheria-pertussis
used.
12
and tetanus
Synapse / synaptic junction（突触）
high nerve cell, central nerve cell
peripheral
motor neuron
excitatory transmitter, inhibitory transmitter
inhibit,
excite
Endotoxins
of
gram-negative
microbial
cell
wall.
Endotoxins
polymers
that
form
part
membrane
of
of
collapse
made
of
the
the
circulatory
of
Their
the
system.
to
the
lipopolysaccharide
structure
bacteria.
include
intrinsic
the
effects
induction
Much
outer
are
of
lethal
effort has been
to produce protective antibodies against endotoxins for
administration
and
are
the
gram-negative
myriad （very large）， they
are
to patients
monoclonal
yet
led
in
antibody
to
shock。 Despite
technology， this
significant
advances
broad
strategy
reactivity
has
not
for the treatment of
endotoxemia。
Exotoxins are secreted
③Capsule / Microcacapsule
Some of bacterials have capsule / microcacapsule ( e.g. the
polysaccharide
has
been
impede
capsule
shown
to
migration
of
of
Cryptococcus
impair
host
leukocytes.
13
neoformans )
phagocytosis
Capsule
and
which
may
elements also
activate
the
significant
system ， which
complement
probably
has
a
effect on host defense。 Like a suit o f armour
or bulletproof vest.
④Enzymes
( produced
Enzymes
by bacteria )
produced
destruction。 such
by
bacteria
as collagenase
can promote tissue
dissolve
collagens,
protainase
dissolve protains, hyaluronidase ( spreading factor )
⑤the
number of pathogen entering muman body
According
bacteria
tissue,
are
to
entering
the
some
wound
surgical
necrotic
test
is
of
tissue,
the surgical
more
infection
tissues,
number
data,
bacteria
if
hematoma
entering
106
than
could
the
in
occur,
or
wound
of
1
of
gram
but
foreign
102
is
number
if
there
bodies,
in
the
1 gram of
infection could occur.
Human body’s factors tending to suffer from surgical infection
①Local
factors
The
defects
skin
and
body
from
mucous
in
of
skin
mucous
and
mucous
the
first
are
bacteria.
If
someplace
of
there
body,
is
membrane----- the intact
barrier
the
protecting
defect
pathogen
muman
of
skin
and
could
enter
the
wound directly and surgical infection occurred.
The
block
of
tracts----- biliary / urinary
14
tract, appendic
cacity,
the block of proximal end / distal end, the contents ( urine,
bile, mucus, blood
could
be
) would
good
be
culture
stasis.
/ nutrient
favourable condition for bacterial
The
disturbance
stream,
blood
of
blood
stasis
medium
content
which
is
growth and reproduction.
stream------
stasis
of
blood
coagulation
The primary illness
②Systemic
The
of skin and mucous membrane--------
Factors
The serious shock, trauma,
The massive glucocorticoid
radiotherapy for
malignant
The serious malnutrition,
diabetes, uremia
hormone therapy, chemotherapy and
tumor
hypoproteinemia,
leukemia
AIDS
Pathophysiology
The pathophysiology
process
or
of
inflammatory
systemic.
inflammatory
Surgical
since
the
of
Many
the
reflection，
advent
for
of
antibiotics
remains a common complication
Acute
inflammation
is
disorders
often
infection
the
15
infection
which
surgical
processes， most
admissions
surgical
resulting
have
but
could
is
be
result
the
local
from
from
infection.
markedly
decreased
unfortunately， infections
of operative surgery.
principal
mechanism
by
which
the
living
inflammatory
agent,
the
to
tissue
This
has
is
the
three
to
or
formation
of
neutralize
an
the
phenomena
signs
serum,
are
of
injurious
and
restore
of
inflammatory
acute
exudate.
leucocytes,
exudates
collectively
Celsus” (
of
the
feature
inflammatory
which
purpose
tissue
central
components:
of
The
necrotic
The
principal
“ Cardinal
the
injury.
function.
Formation
vascular
to
is
damaged
to useful
fibrinogen.
three
respond
response
remove
inflammation
for
tissues
and
involves
responsible
Celsus:古罗马医学百科
全书编辑者。其第三卷载有发炎四标准症：红肿热痛 ) i.e. redness,
swelling, heat, pain, and loss of function.
Dilatation
( 充血 )
of
responsible
and
of
loca l blood
the
for
tissues
the
vessels
and
clinical
leads
increased
signs
of
to
engorgement
perfusion;
this
loca l redness,
is
heat,
some of swelling.
Increased
capillary
permeability
plasma
proteins ( including
passing
into
the
results
in
immunoglobulins
extra-cellular
tissues
serum
and
and fibrinogen )
which
further
increases
the swelling ( edema) .
Pain
is
substances
kinins.
caused
which
The
by
swelling
mediate
the
inflammatory
by
some of
inflammatory
exudates
16
and
serves
to
the
process, e.g .
irrigate
the
area,
diluting
away
form
to
toxins
regional
fibrin
in
and
organisms,
lymph nodes.
the
damaged
which
Fibrinogen
tissue
are
drained
polymerizes
which
inhibits
to
bacterial
spread.
Leucocytes
migrate
into
there,
the
neutrophils
those
from
tissue
debris. Macrophages
after
a
blood
burst
pyrogens
area
of injury
and macrophages( both
monocytes ) commence
of
which
the
are
long-lived
lysosomal
are
at
fever often associated
activity,
least
and
tissue-fixed
and
phagocytosis
of
neutrophils
die
but
releasing
partly
once
endogenous
responsible
for
the
with acute inflammation.
Outcomes of Acute-Inflammation
①Resolution
actual
If tissue damage is minimal and there is no
tissue
necrosis,
eventually
settles
with
evidence
no
and
then
the
of
the
tissue
acute inflammatory response
returns
scarring.
A
resolution of sunburn or transient
②Abscess
(
dead
walled
Formation
and
off
formation
dying
by
a
occurs
microorganisms
An
zone
acute
particularly
which
attract
17
good
to
example
normal
is
th e
peptic gastritis.
abscess
neutrophils
virtually
plus
is
a
collection
proteinaceous
inflammation.
in
neutrophils
exudates )
Acute
response
and
of pus
abscess
to
certain
yet
are
resistant
to
formation
tissue
phagocytosis
also
necrosis
( e.g.
wood
infection
gut,
contents.
nearest
is
) ,
destruction.
it
dranage
progressively
leading
with
showers
of
( bateraemia )
but
of
and spleen
the
process
liver
is
are
responsible
surface
(
e.g.
to
thereby
healing.
causing
runaway
their
is
enlarges
to
deep
in
much
mechanisms
local
If
are
infection
sepsis.
and
well-localised
abscesses,
enter
the
circulation
mopped
before
for
“point”
to
( e.g.
defence
bacteria
cases.
surface
local
small
although
agent
leads
a
bodies
discharging
( cellulites ) and sometimes systemic
Even
these
epithelial
injurious
from
foreign
tend
the
Sometimes
overwhelmed,
in
eventually
far
localized
material ),
),
spontaneous
abscess
suture
Abscess
highly
organic
abscesses
the
Provided
destruction.
to
be involved
bronchus
eliminated,
breast
some
linen
also
to
response
to
treatment,
spontaneously
skin,
and
may
lysosomal
in
splinters,
Without
an
occurs
or
a
up
general
by
they
the
can
swinging
phagocytic
proliferate.
cells
This
pyrexia （ continuous
fever/稽留热， remittent
fever 弛张热 ) which is characteristic
of
site
an
abscess.
The
may
18
not
be
clinically
apparent
if
the
abscess
pelvic
very
In
the
abscess ).
of
neutrophils
they
are
marrow,
cell
is
thus
a
infection
in
the
an
of
abscess,
rises
numbers
neutrophil
signals
a
pyogenic
number
the
(
more
as
bone
i.e. white
than
infection.
response
circulation causes
or
dramatically
from
with
excessive cytokine
systemic
the
leucocytosis
15 x 109 %
than
usually
with
greater
marked
greater
neutrophils )
presence
( e.g. subphrenic
the bloodstream
released
count
into
in
deep-seated
80%
Severe
spilling
over
sepsis
and
dose
not
systemic
rapid clinical deterioration.
If
spontaneous
eliminate
the
persists
and
injurious
pus
forms,
This
sinus or
discharges
abscess
may
of
agent,
continues
chroni c abscess.
discharging
drainage
be
to
may
a
and
be
be
surface
then
an
abscess
the
neutrophil
formed,
manifest
abscess
resulting
only
the
essential
principle
establish
complete
drainage,
Any
residual
eliminated
by
of
which
intermittently
because
managing
usully
by
necrotic
or
foreign
curettage
or
excision.
19
a
continuously
of
effects ( e.g. swinging pyrexia ). From the foregoing,
that
in
as a
heals. Alternatively
suspected
response
any
a chronic
its systemic
it follows
abscess
incision
material
is
to
or aspiration.
must
be
Indeed , before the
antibiotic era,
admission
with
abscesses
and
most
the
abscess
cure
principle
a
of
major
drainage
cause of hospital
was
are
has
because
often
fully
the
remains
and
bacteia
within
misused
formed,
pus
the
treat
antibiotics
and
antibiotics
to
sometimes
foreign
cannot
or
gain
seldom
are
eliminated
before
as
given
an
early
enough,
the
stage
example
staphylococcal
breast
lactation
and
if
formerly
untreated
common
often
are
lead to
surgical
problem
a
particular
dramatically
risk
reduce
of
the
appropriate
can
prophylactic
incidence
of
be
For
common
during
breast
is
abscesses;
now
rare
practioners.
where there is known
infection,
halt
formation.
because of timely antibiotic treatment by family
Likewise, in surgical operation
may
organisms
infections
to the
sterile abscess
If
of abscess
a
material
access
antibiotics
antibioma.
Once
effect
necrotic
ready
pus; nevertheless,
known
antibiotics
this
known
abscesses.
expansion or even sterilize the pus; the residual
is
well
hospital having a separate septic word.
Antibiotics
an
were
to be
antibiotics
postoperative
can
abscess
formation and other septic complications.
3.Organization and Repair
The
most
common
sequel
20
to
acute
inflammation
is
organization
in
phagocytosis
and
the defect
filled
as
granulation
tissue.
tissue
is
known
gradually
which
repaired
dead
to
tissue
bring
some cases the original tissue
The
simplest
healing
there
of
is
wound
an
brought
inflammation
the
necrotic
response
incision
and
bridges
the
surface
epithelium
invade
the
that
after
the
liner
as
the
dermal
rapidly
is
At
blood
vessels
gradually
scar
within
a
healing
by
secondary
granulation
apposition
with
in
few
the
third
and
tissue
In
In
suture.
the
regress
down
scar
and
is
it
of
tissue
Fibroblasts
still
becomes
/
intention
process
is
so
removal
red
but
a
pale
known
( healing
healing
wound
contaminated wound / 感染伤口 infected wound ).
21
vicinity
suture
This
三 期 ， 清 洁 伤 口 -aseptic
the
acute
collagen,
permit
/ 二期愈合,
of
granulation
months.
first
case,
An
epidermis.
laying
stage
this
is
meantime, proliferation
the
to
In
immediate
the
repair
margins
day,
enough
this
primary
intention
the
tissue
days.
fibrous scar.
incision.
restores
strong
a
and
defect.
by
connective
granulation
organization
skin
the
granulation
repair
5-10
of
develops
by
vascular
This
about
tissue
into
by
removed
may regenerate.
uncomplicated
no
are
example
is
by
by
third /
/ 污染伤口
If
tissue
together,
loss
the
prevents
healing
deficiency.
The
which
becomes
later
from
the
wound
process
defect
healthy
the
is
has
wound
to
initially
invaded
by
edges
good
the
with
good
clot
filled
The
coming
make
vascular
base.
from
granulation
inflammatory
tissue
exudates
solidifies at the surface forming a protective scab. Fibrin in
the
clot
contract,
together,
reducing
invade
in
the
the
extracellular
shrinks
after
months,
contraction
is
a
than
defect
succeeding
avascular
the
that
original
edges
whole
surface
of
process
by secondary intention.
22
the
is
of
collagen
scar;
ensure
the
about
weeks
more
The
on
The
within
margins.
other
shed.
myofibrils
briaged
each
eventually
down
gradually
slide
the
lain
beginning
and
edges
Fibroblasts
is
is
wound
beneath
of
the
wound
defect.
defect,
collagen
the
and
collagen
relatively
from
tussue
and
regress
proliferation
over
the
Over
smaller
the
of
wound
mature
epidermal
draw
contraction
vessels
the
much
overlying
spaces.
blood
of
tissue
insult.
leaving
to
size
the
the
the
formed,
scar
the
granulation
fibroblasts
weeks
helping
is
the
final
defect.
The
epithelial
epithelial
the
known
and
gradual
by
scab
3
cells
granulation
which
as
is
healing
The
rate
impaired
and
by
a
success
variety
of
tissue,
foreign
bodies,
necrotic
blood
supply,
continued
dressings
as
and
as
by
wound
local
with
In
long
the same
original
of
circumstances,
period
time
and
acute
causing
the
the
body
aera
concurrently, i.e
response, granulation
Chronic
such
by
unsuitable
the
as
injurious
continuing
to
tissue
patient,
malnutrition,
between
a
body’s
reparative
response.
agent
is
range
agents
23
by
both
the
several
process
In
theses
pathological
an inflammatory
and fibrous scarring.
a
Healing
and
with
repair.
tenuous （ 薄 弱 ）
injurious
removed
of
the
necrosis,
manner but often with much
wide
deal
exhibits
persistent
persist
At
and
represents
agent
tissue destruction.
damage
tissue formation
inflammation
injurious
an
tissue
balance
A
damaged
diabetes.
orgnisation
damaged
processes
usual
wound
factors
attempts
continuing
inflammation,
cases, the
the
or
Inflammation
certain
over a
poor
be
retained
contamination,
the
systemic
may
including
infection,
immunosuppression and uncontrolled
④Chronic
healing
factors
wound
interference
well
of
only
then
agent
and
take
place
proceeds
in
the
if
the
more scarring.
can
lead
to chronic
inflammation
grouped
and
into
ulcers,
the
three
the
clinical
patterns
categrious:
specific
of
chronic
disease
can
abscesses,
granulmatous
be
chronic
infections
and
inflammation.
Clinical Manifestation and Diagnosis
The
clinical
Examination
Manifestations
② Laboratory
Generally speaking, according
are
three
aspects:
Findings
the
① Physical
③Imaging
results
of
theses,
Studies.
we
can
obtain a correct diagnosis for surgical infection.
①Physical Examination
Inspection
Palpation
Percussion
Auscultation
(望/触/叩/听诊)
Temperature can be elevated.
Physical
examination
is
the
easiest
way
surgical infection. When infection is suspected
found
initially,
warmth,
to
erythema,
developing
examination
repeated
is
examination
induration,
abscess.
the
tenderness,
Failure
most
will
to
common
24
to
localize
a
but cannot be
often
reveal
subtl
or
splinting
due
repeat
reason
the
physical
for delayed
diagnosis
and
periumbilical
therapy.
to
( eg. Migration
the
right
lower
of pain
from the
quadrant + localized
tenderness over McBurney’s point = dignosis of appendicitis )。
②Laboratory Findings
Blood
routine
elevated ,
the
neutrophils
and
Leukocytosis
examination
differential
leukocyte
leukocytoblast
may
The
which
leukocyte
count
means
count
is
shows more
severe
infection.
give way to leucopenia when the infection is
severe.
Identification of
Bacteria
Smear examination
Bacterial
urine
are
know
which
surgical
Culture
The
collected
routinely
kind
bacteria
of
infection
and
blood,
and
is
which
pus,
drain,
cultured
the
kind
in
pathogen
antibiotics
sputum,
order
to
causing
the
is
sensitive
to the pathogen.
Organ
heart,
function
lung
can
hepatic,
renal,
strong
evidence
and
Tests
be
and
The
innormal.
gastric (
for sepsis.
signs of disseminated
functions of liver,
Unexplained
ie, stress
Acidosis
intravascular
as well.
25
respiratory,
ulsers )
is helpful
kedny,
in
coagulation
failure
is
diagnosis,
are
useful
③Imaging
Studies
Radiological
for
the
examination is frequently helpful， particularly
diagnosis
of
bone ， radiologic
infection
is
close
to
indicated
to
detect
early
might
require
therapy。 CT
in
particularly
Numerous
useful
is
in
are
gallium (
The
67
scanning
scans
best
Ga
)
for
or
is
antibiotic
detecting
and
abscesses
unltrasonography
are
occult （ 隐 匿 ） infection.
have
been
tested,
for
labeling
radionuclides
and
examination
surgical
usefull
Whenever
osteomyelitis ， which
of
localizing
radionuclide
results,
signs
aggressive
scanning
fair
magnetic
more
organs 。 CT
solid
infections 。
pulmonary
111
indium(
In
).
all
with
leukocytes
NMR ( nuclear
resonance )
Prevention
Including
three
aspects— patient,
cilinical
staff, and
enviroument
For doctor and nurse:
① Teaching
the
priciples
of
asepsis
to
clinicl
staff
and
keep them during injecting, operating, nursing, inserting urethral
catheter,
inserting
venous
cannula,
etc
②Correctly using antibiotis
26
doing
dressing
change
③Correctly treat the wound
Treatment (Local and Systemic)
Local
① Protecting infectious aera from crush and limiting activity
or fixing to abate pain
② Physiotheapy , drug
for external, some of chinise drugs
③ Operation:
a. Incision and Drainage
Abscesses
must
tissue, and toxins
the
munber
of
this decreases
Fluctuation
bacteria
for
may
this
an
is
a
signs,
second
abscess
a
catheter
Abscesses
serious
intention
difficult
and
to
placed
infected
is a
reliable
become
wound,
the
of toxins
manifestations
never
open
in
spread
subcutaneous abscess.
aera
opened
bacteria, necrotic
drained to the outside. The pressure and
the
with systemic
be
with
drain
bacteria.
but
late
the
fluctuant,
tissue
surgically
percutaneously
if
result.
abscess
under
a
perianal
waits
Drainege
creats
little
may
or
of
surgen
will
remarkably
27
lowered;
An
sign
parotid
and
may
the
or ultrasonography.
are
surgical emergency.
in
sepsis
but
and
space
heal
by
scarring. deep
be
drained
guidance
by
by
CT
It
may
appear
that
a
patient
withstand
operation.
In
may
be
the
important
One
can
bowel
most
hardly
because
substitute
for
fact,
imagine
the
operation
of
of
is
the
to
all
delaying
patient
obliteration
with
sepsis
drain
an
therapeutic
emoval
cannot
of
shock.
There
focus of
infection
abscess
measures.
infracted
is
no
when
it
is surgically accessible.
b.Excision
Some
of
example,
if
appendicitis ,
appendix).
and
infection
someone
we
In
patient
myositis
surgical
can
these
is
may
suffers
excise
cured
may require
on
fro m
his
cases, drainage
the
be
For
cholecytitis
or
infected
may
not
operating
amputation
excised. (
of
the
gallbladder
be
table.
infected
or
necessary,
Clostridial
limb.
The
success of such operation is greatly facilitated by intensive
specific antimicrobial therapy.
( Gas
angrene:
Clostridium
progressive
life.
It
general
perfringens,
infection
typically
presence
of
conditions
include
considerations
is
an
that poses
o ccu r
in
extremely serious, rapidly
imminent
settings
contaminated,
usually caused
risk
to limb
characterized
by
an d
the
devitalized tissue. Predisposing
traumatic injuries
28
such as compound fracture,
penetrating wound, surgical wounds after
libm
injuries
in
the setting of advanced arterial insufficiency.
Clinical Findings:
usually
enteric surgery, and
There is rapid destruction of muscle and
severe
systemic
toxicity. Prompt
debridment
of
all
nonviable tissue, often leading to amputation, is essential for
c u re .
At
surgery,
involved
muscle
is typically
edematous and dose not contract when probed.
of
gas
gangrene
is
sudden,
and systemic toxicity.
the
surrounding
discharge
may
becomes
dusky
may
be
tissue
When
highly
the
an d
fluid-filled
in
is
may
g as
be
drug
hypotention,
the
performed,
tissue
bullae.
addition,
generally
l ead
to
with
encountered
loss
have
of
Syetemic
body temperature, take rest
G
Severe
or
gas
d eat h .
demonstrated
is
surgical
of
gas
with
libm
been
Prompt
removal
29
In
finally
Complications
penicillin
choice.
serous
surrounding
tissues.
gangrene
of
a blood-tinged,
tissue.)
① Lowering
The onset
severe pain,
pale;
suspected, high-dose
considered
should
with
which
Treatment
is
be noted;
destruction
gangrene,
and
The affected libm become edematous;
skin
palpable
with
p al e
all
or
generally
debridement
devitalized
② Taking
food
which
should
be
high
quantity
of
heat ,
easy to digest, full of Vitmine B and C
③Circulatory Enhancement:
a re a s ,
Chronic infections in poorly vascularized
as in osteoradionecrosis,may be cured by transplanting
functioning
vascular
b ed (
eg. a musculocutaneous
fl a p
a
or
omental transposition ) into the affected area.
④Antibiotics
Antibiotics
infections
that
furuncles
likely
a re
not
respond
and
necessary
to
uncomplicated
fo r
simple
incision
and
wound
infections.
dranaige
to spread or persist require antibioti
chosen on the basis of sensitivity
including
septic
empirically
results
into
of
an d
the
blood
account
similar
shock, antibiotics
regimen
cultures.
the
infections
The
organisms
in
surgical
alone
Infections
therapy,
b es t
tests. In toxic infection,
must
started
modified
choice
most
previous
promptly
an d
from
the
must
take
later
of
drugs
often
patients,
cultured
fro m
the results of
gram-stained smears and specific characteristics of the patient.
⑤Nutritional Support
In
the
malnourished,
ability
enhanced
to
by
ward
septic,
off
aggressive
or
or
severely
recover
nutritional
30
traumatized
from
patients,
infection is often
therapy.
Specific
measurable
effects
include improved
immunocompetency and
blunting or reversal of catabolism. Protection or restoration of
visceral
and
skeletal
muscle
allows
the
patient
to cough
better and be more mobile.
⑥Fluid infusion(intravenous):
Fluid
replacement
maintenance
should
requirements,
be
based on the following: (1)
(2) extra needs
fever,burns etc), (3) losses from drains,
an d
(resulting from
(4 )
requirements
resulting from tissue edema and ileus ( third space losses).
Fluid
requirement
must
order
should
rewritten
be
be
evaluated
24
frequently.
hours
or
Intravenous
more
often
if
indicated by special circumstances.
⑦Correcting
⑧Treating
of Electrolyte abnormalities
of systemic disease
(
eg.
Chronic
uremia, HIV infection, diabetes, anemia,
hepatic disease,
hypoproteinemia )。
Reference Materials:
①David
C. Sabiston: Textbook of Surgry.W.B Saunders Company.
② H.George Burkitt:Essential Surgery.Harcourt Asia
③ Walter R.Wilson and Merle A.Sande:Diagnosis & Treatment in
Infectious Diseases.McGraw-Hill,2001
Question:
1.How do you understander the concept,classification,cause of
31
disease,prevention,clinical manifestitation,diagnosis of the surgical
infection
2.Please write out the local and systemic principles of management of
surgical infection
3.Please answer the concept,cause of disease，diagnosis，principles of
management of the septicopyemia
4. Please answer The clinical
manifestitation, prevention,
principles of management of the specific surgical infection
( Tetanus, Gas Gangrene ).
Summary:We
of disease,
learned ① the concept,
have
prevention,
surgical infection. ②
clinical
classification,
cause
manifestitation, diagnosis of the
the local and systemic principles of
management of
surgical
infection. ③ the diagnosis and
management
of
the
the principles
pyogenic infection of superficial
of
tissues and
hands.
③ the concept,cause of disease，diagnosis，principles of management of
④ The septicopyemia.⑤ the cause of disease, pathologic changes,
clinical
manifestitation,
management of
prevention,
the specific surgical infection
principles
(
Tetanus,
of
Gas
Gangrene ).⑥ the common pathogens, clinical manifestitation,
diagnosis,
principles of
management of the systemic surgical
32
infection. We
of disease,
management
must
clinical
of
pay
special
1.
The cause
manifestitation, diagnosis, principles
surgical infection.
disease, diagnosis ， principles of
septicopyemia. 3. The clinical
principles
attention to
2. The concept, cause of
management of
manifestitation,
of management of the specific surgical
( Tetanus, Gas Gangrene ).
33
of
the
prevention,
infection