Surgical Infections What are the causes?

What is infection? Break down in the balance between Host defences Systemic Loco-regional Dead space = barrier to defences Collections & “Omas” Haemat /Ser Foreign Bodies – intentional or accidental Necrotic Tissue Micro-organism Virulence Quantum Synergism

What is Surgical Infection? Assume Immunocompetence No Immunosuppressive medications No major co-morbidities Basic Aseptic Protocols are followed Host Factors Location Blood supply Previous sugery obseity

Surgical Factors Poor Tissue Handling > Necrosis Lack of anatomical understanding Knowledge of blood supply! Ignorance of previous procedures Cautery / Ablation Tension Poor Haemostasis = Haematoma Poorly managed Cavities = Seroma Poorly introduced Foreign Bodies = Extrusion Biofilm Infection

Preoperative Prevention Patient Selection Not everyone is a surgical candidate! Consider Co-Morbidities Optimisation Non-surgical alternatives Patient Preparation Medications Anticoagulants Hypoglaemics Smoking!! Hygiene Antibacterial washes / Site inspection – no dirt!! Antimicrobial Prophylaxis is not a substitute for for good preparation

On Table Prevention Appropriate Respect for tissues Good Haemostasis Field preparation / Prophylaxis Respect for tissues Minimise necrosis Avoid ischaemia / tension Good Haemostasis Aseptic implant (all FBs) handling Management of Dead Space Compartmentalise / Quilting Drains Compression

Postoperative Prevention Specific Postoperative instructions Reduce swelling = RICE Early detection of ischaemia Antibiotics only if indicated – not a substitute for good management Early Intervention Remove constriction Drain Haematomas / Seromas / Abscesses Remove FB’s if warrented Debride Necrotic tissue