General Surgery
Mosul university- College of dentistry-oral & maxillofacial surgery departmentDr. Ziad H. Delemi B.D.S, F.I.B.M.S. (M.F.)
Surgical infections Ι
Mosul university- College of dentistry-oral & maxillofacial surgery department
Types of woundClean ( nearly 2-3%) like: Incised wounds
Mosul university- College of dentistry-oral & maxillofacial surgery department
Types of woundclean contaminated ( 20-25%) like: Lacerated wounds
Mosul university- College of dentistry-oral & maxillofacial surgery department
Types of woundInfected (30% & more) like: Bullet wounds
Inlet out let
Mosul university- College of dentistry-oral & maxillofacial surgery department
Keloid scar
hypertrophic scarMosul university- College of dentistry-oral & maxillofacial surgery department
Mosul university- College of dentistry-oral & maxillofacial surgery department
Surgical infectionsIt is an infection which follow the operation ( wound infection or post. op. abscess) which is unlikely to respond to conservative treatment & must be excised or drained eg: abscess , empyema, gas gangrene. Factors influencing the body to infection: General factors : chronic diseases anemia, uncontrolled DM. patient on steroid therapy. Agranulocytosis. Hypogammaglobulinemia. Local factors: hematoma, crush injury, bone injury, foreign body.
Mosul university- College of dentistry-oral & maxillofacial surgery department
Hospital infection (Nasocomial)Infections results from transmission of pathologic microorganism (M.O.) to previously uninfected wound such M.O. are resistant bec. the patient receives prolonged antibiotic treatment. The M.O. found in the ward, operation theater, surgeon, assistant, or cross infection from other patient, or autoinfection from the patient himself in which the wound is contaminated by his cough droplet. Most common M.O. is staph. which is found in anterior nares & perineum.
Mosul university- College of dentistry-oral & maxillofacial surgery department
Hospital infection (Nasocomial)The most common M.O. are:1- Staph. : G+ cocci facultative anerobic found in nose & throat, hospital tools, clothes. It produces coagulase, staphylokinase, hyalourinidase, enterotoxin . Lesions: boil, carbuncle, o.m., abscess, wound infection.2- Strep. : G+ cocci aerobic & facultative anerobic, 3 types (α- hemolytic viridance,β- hemolytic pyogens, γ-hemolytic fecalis) It produces streptokinase, hyalourinidase, streptolysin O& S & exotoxin, found in mouth, pharynx. Lesions: Erysipelas, scarlet fever, RF, tonsillitis, impetigo, glomerulonephritis, Nec.Faci.
3- G-ve bacilli: rods facultative anerobic produce endotoxin found in the large bowel . Like E. coli, proteus, pseudomonas, klebsiella, bacteriods.4- clostridia: large G+ve rods, drum stick appearance, spore forming, obligatory anerobic normal inhabitant in the intestine & the soil. Types: cl. Tetani, cl. Welchii, cl. Sporogens. occur due to soil or dirty wounds bullet shell piece clothes piece. It has powerful exotoxin cause tissue & CNS damage. Signs: ↑ temperature, stiff jaw, dysphagia, tonic muscle spasm in the face resus sardonicus, difficult breathing, reflex contraction, death from asphyxia. Mosul university- College of dentistry-oral & maxillofacial surgery department
1-Tetanus
1- prophylactic management: a- active immunization: by injection of absorped toxoid which is safe.( used for prophylaxis ) b- passive immunization: every patient with crush injury or wound who has no active immunization should take 1500 IU of ATS inj. I.M. or human antitetanus globulin 250 IU I.M. 2- symptomatic treatment of spasm by: anticonvulsant muscle relaxant, artificial respiration, antibiotic penicillin
Mosul university- College of dentistry-oral & maxillofacial surgery department
Treatment of Tetanus
2- Gas gangrene
Caused by cl. Welchii some times cl. Septicum usually affects wound of the thigh & buttock because these areas are liable for fecal contamination & lead to amputation. the etiology either by trauma, war injury, industrial. Or DM & atherosclerosis or post op. laparotomy or lower limb amputation or septic abortion. The infection starts as a simple contamination in which the M.O. digest the tissue & seropurulant discharge but no gas or toxin. Treated by AB. If not the condition change to cl. Cellulitis gas crepitation with infection involve subcutaneous tissue but not the muscle which is intact if not treated cl. Myonecrosis or myositis ( actual gas gangrene ).Mosul university- College of dentistry-oral & maxillofacial surgery department
2- Gas gangreneClinical picture : pain, edema, swelling, crepitus by palpation, toxemia, ↑↑ temperature, ↑↑ pulse rate.Management:1- Prevention: a- excision of the whole dead tissue until fresh bleeding appear. b- prophylactic AB. c- antigas gangrene serum 22500 IU2-Treatment: a- immediate pos. op. Blood transfusion with adequate excision of dead tissue & muscle & even some times leg amputation if not respond to treatment. b- broad spectrum AB. ( penicillin, flagyl, garamycin). c- AGS d- hyperbaric oxygen
Mosul university- College of dentistry-oral & maxillofacial surgery department
2- Gas gangreneMosul university- College of dentistry-oral & maxillofacial surgery department
2- Gas gangreneMosul university- College of dentistry-oral & maxillofacial surgery department
Apportunistic infection
A- reduced host defense (immune decreased ) seen in : 1- immune suppressive therapy, 2- cytotoxic & steroid Rx. 3- radiotherapy for neoplasm, 4- sever burn, 5- starvation, 6- long term use of AB., 7- AIDS 8- very old & very young (premature baby). B- maintained invasive therapeutic procedure: 1- I.V. cannulation 2- intravesical catheterization 3- trachiostomy & pulmonary ventilation.
Mosul university- College of dentistry-oral & maxillofacial surgery department
Apportunistic infectionThe commonest M.O. are G-ve (E. coli, pseudomonas, klebsiella, proteus. They originate either from the patient own GIT, or by cross infection from other patient in the hospital & spread by hands of the attendants. G+ve M.O. staph. Epidermidis derived from skin lead to local infection or bacterimia, often associated with IV or CV line prosthesis to the heart or joint, upper renal tract catheterization. Following splenectomy lead to strep. Pneumonia Viruses ( Herpes, CMV, V-zostar) Fungal ( Candida, Aspargilosis, mucourmycosis) Protozoa ( cryptosporidial diarrhea, pneumocystis carinii pneumonia)
Mosul university- College of dentistry-oral & maxillofacial surgery department
QuizPfannenstiel incision used in ……………..