Surgical Infection. Acute Purulent Infection of the Skin and Cellular Spaces. Reader: Kushnir R.Ya. Lecture:

Surgical Infection.Surgical Infection.Acute Purulent Acute Purulent

Infection of the Skin Infection of the Skin and Cellular Spaces.and Cellular Spaces.

Reader: Kushnir R.Ya.Reader: Kushnir R.Ya.

Lecture:Lecture:

Classification of the surgical Classification of the surgical infectionsinfections

Acute surgical infections.Acute surgical infections. Chronic surgical infections.Chronic surgical infections.

Acute purulent surgical Acute purulent surgical infectionsinfections

Acute purulent aerobic infections.Acute purulent aerobic infections. Acute anaerobic infections.Acute anaerobic infections. Acute specific infections.Acute specific infections. Viral infections.Viral infections.

Acute Purulent Aerobic Acute Purulent Aerobic InfectionsInfections

The cause of the most frequently The cause of the most frequently purulent surgical infections it's:purulent surgical infections it's: Staphylococcal infections.Staphylococcal infections. Streptococcal infections.Streptococcal infections. Gram - negative infections.Gram - negative infections. Mixed bacterial infections.Mixed bacterial infections.

Five classical local signs of Five classical local signs of inflammation are:inflammation are:

Heat-the inflamed area feels warmer than Heat-the inflamed area feels warmer than the surrounding tissues.the surrounding tissues.

Redness of the skin over the inflamed Redness of the skin over the inflamed area.area.

Tenderness, due to the pressure of Tenderness, due to the pressure of exudate on the surrounding nerves.exudate on the surrounding nerves.

Swelling.Swelling. Loss of function-an inflamed tissue does Loss of function-an inflamed tissue does

not perform possible its physiological not perform possible its physiological function.function.

Boil (Furuncles)Boil (Furuncles) Boil constitute one of the very widespread purulent Boil constitute one of the very widespread purulent

diseases of the hair follicle and sebaceousdiseases of the hair follicle and sebaceous

Boil (Furuncles)Boil (Furuncles)

Boil (Furuncles)Boil (Furuncles)

ComplicationsComplications

boil may lead to cellulilis, particularly boil may lead to cellulilis, particularly in those whose power of immunity is in those whose power of immunity is less.less.

boils may also lead to infection of the boils may also lead to infection of the neighbouring hair follicles where neighbouring hair follicles where numbers of hair follicles are too many numbers of hair follicles are too many (e.g. axilla) leading to hydradenitis.(e.g. axilla) leading to hydradenitis.

boils usually secondarily infect the boils usually secondarily infect the regional lymph nodes.regional lymph nodes.

HydradenitisHydradenitis

TreatmentTreatment The general health of the patient has to be The general health of the patient has to be

improved, as boils often occur in individuals with improved, as boils often occur in individuals with debility and ill-health.debility and ill-health.

Incision is usually unnecessary as the pustule is very Incision is usually unnecessary as the pustule is very small. Only a touch of iodine on the skin pustule will small. Only a touch of iodine on the skin pustule will hasten necrosis of the overlying skin and help the hasten necrosis of the overlying skin and help the pus to drain out.pus to drain out.

If escape of pus does not occur spontaneously or If escape of pus does not occur spontaneously or with application of iodine, removal of the affected with application of iodine, removal of the affected hair allows ready escape of pus.hair allows ready escape of pus.

Antibiotic is usually not required.Antibiotic is usually not required. After escape of pus this placet should be cleaned After escape of pus this placet should be cleaned

twice with a suitable disinfectant e.g. twice with a suitable disinfectant e.g. hexachlorophene.hexachlorophene.

If boils are recurrent, diabetes should be excludedIf boils are recurrent, diabetes should be excluded..

CarbunclesCarbuncles

After penetration of pyogenic bacteria After penetration of pyogenic bacteria under the skin through hair follicles and under the skin through hair follicles and sebaceous glands the process spreads in sebaceous glands the process spreads in depth, if the conditions are unfavourable to depth, if the conditions are unfavourable to the body, and affects considerable sections the body, and affects considerable sections of subcutaneous tissue. It is an infective of subcutaneous tissue. It is an infective gangrene of the subcutaneous tissue due to gangrene of the subcutaneous tissue due to Staphylococcal (Staphylococcus aureus) Staphylococcal (Staphylococcus aureus) infection. Gram-negative bacilli and infection. Gram-negative bacilli and Streptococci may be found coincidently.Streptococci may be found coincidently.

CarbuncleCarbuncle

CarbuncleCarbuncle

Antrax CarbuncleAntrax Carbuncle

TreatmentTreatment improvement of the general health of the improvement of the general health of the

patient should be brought about.patient should be brought about. proper antibiotic should be started proper antibiotic should be started

immediately from the culture and sensitivity immediately from the culture and sensitivity test.test.

OperationOperation may be required:may be required: when toxaemia and pain persist even after a when toxaemia and pain persist even after a

course of antibiotics.course of antibiotics. when the carbuncle is more than 2 inches in when the carbuncle is more than 2 inches in

diameter. It must be remembered that diameter. It must be remembered that incision is never made unless there is incision is never made unless there is softening in the centre.softening in the centre.

AbscessAbscess

An abscess is a cavity filled with pus An abscess is a cavity filled with pus and lined by a pyogenic membrane. and lined by a pyogenic membrane. This pyogenic membrane consists of This pyogenic membrane consists of dead tissue cells and a wall of dead tissue cells and a wall of granulation tissue consisting for the granulation tissue consisting for the most part of phagocytic histiocytes.most part of phagocytic histiocytes.

AbscessAbscess

AbscessAbscess

TreatmentTreatment

The basic principle of treatment of an The basic principle of treatment of an abscess are:abscess are:

to drain the pus;to drain the pus; to send a sample of pus for culture to send a sample of pus for culture

and sensitivity test;and sensitivity test; to give proper antibiotic.to give proper antibiotic.

ErysipelasErysipelas

It is an acute inflammation of the It is an acute inflammation of the lymphatics of the skin or mucous lymphatics of the skin or mucous membrane.membrane.The causative organism is usually The causative organism is usually Streptococcus haemolyticus.Streptococcus haemolyticus.

ErysipelasErysipelas

ErysipelasErysipelas

ErysipelasErysipelas

ErysipelasErysipelas

LymphangitisLymphangitis

A spread of infection along the A spread of infection along the lymphatic system is manifested in a lymphatic system is manifested in a disease of the lymphatic vessels and disease of the lymphatic vessels and lymph nodes. Inflammation of the lymph nodes. Inflammation of the lymphatic vessels (lymphangitis) is lymphatic vessels (lymphangitis) is one of the frequent complications of one of the frequent complications of infected wounds, especially during infected wounds, especially during the first weeks following injury, and the first weeks following injury, and of local purulent diseases.of local purulent diseases.

LymphangitisLymphangitis

TreatmentTreatment

The treatment of lymphangitis The treatment of lymphangitis consists primarily in elimination of consists primarily in elimination of its cause (incision of the abscess, its cause (incision of the abscess, pockets of the wound, etc.) and in pockets of the wound, etc.) and in giving the affected organ complete giving the affected organ complete rest.rest.

ParaproctitisParaproctitis

is the purulent inflammation of is the purulent inflammation of around-rectal cellular tissue.around-rectal cellular tissue.

ParaproctitisParaproctitis

TreatmentTreatment

In the stage of infiltration In the stage of infiltration conservative therapy usually used conservative therapy usually used (antibiotics, sparing thet). At the (antibiotics, sparing thet). At the phlegmon or abscess there is phlegmon or abscess there is indicated urgent operation.indicated urgent operation.

MastitisMastitis

Mastitis - is inflammation of lactic Mastitis - is inflammation of lactic gland tissue. There is distinguished gland tissue. There is distinguished lactation mastitis at nursing lactation mastitis at nursing mothers, mastitis of newborns and in mothers, mastitis of newborns and in period of pubescence.period of pubescence.

MastitisMastitis