1. Surgical Infections
What are the causes?

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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