Surgical wound infections and all about serious surgery complications

Added: 12/19/2005

Maintaining strict hygiene of aseptic and antiseptic procedures reduce the possible risk of surgical wound infections. But unfortunately contamination during the surgery can be inevitable, as lots of the bacteria causing infections originate within the human body. Postoperative host defence is considered to be the major factor to determine whether the surgical patient becomes infected. That is why it is very important to pay proper attention to surgical infections prevention.

Surgical wound infections are considered to be the common and serious complications of surgery. However, it is not the only one serious complication. Any surgery must be taken into consideration in the context of all possible risks and benefits. Therefore, the article will pay attention to both the risks and benefits of providing supplemental oxygen and maintaining normothermia.

Thus, two factors are known to modulate the immunity: provision of supplemental perioperative oxygen and maintenance of perioperative normothermia. No doubt, other nonpharmacologic factors are also able to influence the risk of surgical wound infections. For instance, avoiding shaving at the surgical site and proper regulation of blood glucose, aseptic and antiseptic procedures are able to reduce the risk of surgical wound infections.

According to scientific studies, the primary defence against various surgical pathogens is their oxidative killing by neutrophils. Oxygen is considered to be the substrate for the mentioned process. Thus, the key element is oxygen transformation into the superoxide radical. The reaction will depend on the tissue oxygen tension through the examined physiological range. Therefore, it is unsurprising that subcutaneous tissue oxygen tension is correlated with the possible risk of surgical wound infections. Thus, factors influencing the tissue perfusion and oxygenation have a significant impact on surgical wound infections. These factors include cardiac output, haemoglobin concentration, local perfusion, perioperative fluid management, anemia, uncontrolled surgical pain and smoking.

It is important to take into consideration that overall incidence of surgical wound infections is between 1% and 3%. However, the incidence is about 10% after colon surgery (this value has not been changed appreciably in several decades). Surgical wound infections are known to cause substantial morbidity. At the same time they are costly and typically increasing the hospitalization duration by about a week.

Surgical wound infections can be treated with antibiotics which are usually efficient during the critical period; but not subsequently. Hypovolemia and local administration of epinephrine increase the risk of infection when given within the several hours of contamination, but not later.

The clinical outcome of surgical wound infections is usually determined by the strength of the host and the one of offending organisms. Regarding incisional surgical site infections surgical infections prevention is the best therapy. At the same time appropriate prophylactic antibiotic is also a must. Further, to minimize any harmful contribution to increased surgical infection rates strict attention must be paid to surgical handling of tissues.

All infection sites require early diagnosis and treatment. However, the major number of surgical wound infections is uncomplicated and relatively straightforward to diagnose clinically. The more complicated cases can be assisted with radiological evaluation.

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