1. Surgical Infection

2. History Lister: 1867 On the antiseptic principle in practice of surgery Louis Pasteur, Ignaz Semmelweis, Theodor Kocher and William S. Halsted Application of antiseptic practices allowed infection rate of operation to drop from 90% to 10%.

3. History Antibiotics: introduced in the middle of 20 th century Hope serious surgical infection eliminated, but this did not occur. Nosocomial infection, widespread antibiotics therapy New techniques: endoprosthesis, transplantation requires immunosuppressive agents, et al.

4. Definition The infection required operative intervention, including that complicated from trauma, operation and burns, et al. Caused by the invasion, resident and proliferation of pathogens, such as bacteria, viruses and fungi et al.

5. Classification: Pathogenesis : Non-specific infection: suppurative infection presentation: redness, swelling, hot, soreness pathogens: Staphylococci aureus, Streptococci. Specific infection: tuberculosis, tetanus, gas gangrene, fungi

6. Classification procession: acute subacute chronic

7. Classification Source of pathogens: Primary Secondary Exogenous Endogenous

8. Classification Opportunity: Opportunistic Superinfection Nosocomial infection

9. Etiology Causes of surgical infection: normal bacterial flora---pathogenic bacteria exogenous bacteria low host resistance

10. Etiology Bacteria factors: adherence toxins: exotoxin, endotoxin numbers of bacteria: 10 5

11. Etiology Local factors: injury of skin or mucosa duct obstruction blood supply skin or mucosa diseases

13. Etiology Systemic factors: severe disease hormone malnutrition AIDS

14. Pathology Non-specific infection: bacteria proliferation leucocyte infiltration inflammatory media and cytokines release congestion, excudation accumulation of serum, blood cells, necrotic tissues redness, swelling, hot and soreness, and dysfunction.

16. Pathology results: alleviate suppurative to spread to be chronic

17. Pathology Specific infection: tuberculosis tetanus gas gangrene fungi infection

18. Diagnosis Clinical presentation: systemic condition local condition organic-systemic dysfunction specific expression Investigation: experiment test imaging: US, X-ray,CT, MRI

19. Management Local treatment: protect infection site superficial lesion deep lesion Antibiotics:

20. Management Improve systemic conditions: hydro-electrolyte, nutrition companion diseases

21. Superficial soft tissue suppurative infection

22. Furuncle Acute suppurative infection within one hair- follicle and surrounding tissue Pathology: acute suppurative inflammation congestion and exudation of components of blood Furunculosis: infection of several hair follicles in a circumscribed area.

23. Furunculoisis

25. Carbuncle A confluent infection involving multiple contiguous follicles in which the infection is limited to the subcutaneous tissue by thick overlying skin and dense subcutaneous fascia. Carbuncles require incision for drainage and treatment.

27. Cellulites acute infection of loosing connective tissue. Pathogens: B-hemolytic Streptococci or Staphylococci aureus Clinical presentation: redness of skin, swilling and boundless Anaerobic cellulites: crepitation Treatment: antibiotics incision and draninage

29. Erysipelas Skin wound local inflammation lymphadenitis systemic inflammation Redness of skin with clear boundary Edema of proximal lymphanode Systemic sepsis

32. Abscess Characterized by a necrotic center without a blood supply and composed of debris from local tissues, dead and dying leukocytes, components of blood and plasma and bacteria This semiliquid central portion (Pus) is surrounded by a vascularized zone of inflammatory tissue.

34. Treatment Incision and drainage Antibiotics

35. Acute suppurative infection of the hand

36. paronychia lateral nail fold trauma redness, pain suppurative infection Treatment: incision and drainage removal of the nail: infection extend deep to the nail antibiotics

38. felon paronychia spread or penetration wound pain fever WBC Treatment: incision and drainage antibiotics

42. Suppurative tenovaginitis, bursitis and infection of palm spaces infection of the flexor tendon sheath, bursts and palm spaces, which is usually caused by a puncture wound to the volar aspect of the digit or palm

44. thenar space midpalmer space hypothenar space Treatment incision irrigation and drainage antibiotics