Wound infection in gynecology

The most common complication of the postoperative period in surgery is suppuration of the postoperative wound.

According to the classification of M.I. Kuzin (1977), the course of the wound healing process is divided into phases:

Phase I - inflammation:

• period of vascular changes - the main role is played by proteases, kinins and amines (histamine, serotonin);
• the period of wound cleansing from necrotic tissue.

In uncomplicated cases, phase I lasts 3-5 days. Upon examination, minor pain, swelling and hyperemia of the wound edges are noted, and there is a tight contact of its edges. There is no discharge from the wound.

Phase II - regeneration: the appearance of granulations (shiny, fine-grained, pink or crimson formations that bleed profusely). The granulation barrier prevents infection from penetrating the wound. In an uncomplicated course, phase II ends by the 8th-10th day with the formation of a narrow linear skin scar.

Phase III - reorganization of the scar and epithelialization: the wound is completely filled with granulation, concentrically reduced.

Conditions for wound healing by primary intention:

• contact of the wound edges (diastasis no more than 10 mm);
• maintaining tissue viability;
• absence of hematoma and foci of necrosis;
• asepticity.

The main pathogens of wound infection at present are gram-positive aerobic cocci - Staphylococcus aureus (up to 90% of all wound infections), other types of staphylococci, as well as streptococci; gram-negative aerobic flora (intestinal and pseudomonas aeruginosa) are less common.

In patients operated on for chronic purulent diseases (all complicated forms of purulent inflammatory diseases in gynecology), associative flora with a predominance of gram-negative (E. coli and Pseudomonas aeruginosa) is more often isolated.

Wound Infection - Causes and Pathogenesis

Most often, wound suppuration occurs on the 5th-8th day after surgery.

The clinical signs of wound suppuration are listed below.

1. The appearance of local signs of infection:
   • the presence of pain in the wound area, which usually increases in nature (at first constant pressing, then “jerking” or pulsating) and decreases only after treatment or drainage of the wound or in the case of spontaneous appearance of wound discharge;
   • the appearance of hyperemia and edema in the wound (suture) area;
   • divergence of the wound edges, appearance of serous or purulent discharge;
   • local hyperthermia.

Wound Infection - Symptoms

The leading method of diagnosing wound infection is clinical. Inspection and probing of the wound: in case of infection localized in the tissue, the leading signs are infiltration and soreness of the suture, in case of suppuration, hyperemia of the skin and areas of fluctuation appear. In case of hematomas of the subcutaneous tissue, there is usually imbibition of the skin with blood in the corresponding area. The diagnosis is easily confirmed by spreading the edges of the skin wound.

Wound Infection - Diagnosis

Tactics of managing patients with wound infection. There are different views on managing patients with wound infection. The differences mainly concern the degree of surgical intervention in the wound process.

Principles of active surgical treatment of purulent wounds:

• surgical treatment of a wound or purulent focus;
• drainage of the wound using a perforated polyvinyl chloride drainage and prolonged washing with antiseptics;
• the earliest possible closure of the wound using primary, primary delayed, early secondary sutures or skin grafting;
• general and local antibacterial therapy;
• increasing the specific and non-specific reactivity of the body.

Wound Infection - Treatment