Wound Infection - Symptoms

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.
2. The appearance of a general reaction:
   • deterioration of general condition (weakness, loss of appetite, sleep disturbance);
   • increase in temperature - a wound infection is characterized by a hectic fever - hyperthermia (above 38° in the evenings with a decrease in temperature to normal and subfebrile in the morning;
   • the appearance of chills;
   • the appearance of symptoms of intoxication - tachycardia, a feeling of dry mouth, "being broken", muscle pain;
   • inflammatory changes in the blood (increased ESR, increased number of leukocytes, shift in the leukocyte formula to the left, lymphopenia).

As a rule, the general reaction of the body (purulent-resorptive fever) during a wound infection always corresponds to the size of the changes and the nature of the process.

If local changes do not correspond to the general condition, the following should be assumed:

• the presence of other purulent foci (abscess formation in the pelvis and abdominal cavity, pneumonia, etc.), which must be identified, since there is often a combination of wound infection and infection in the area of the surgical intervention;
• the presence of a particularly virulent pathogen of wound infection (anaerobes, Pseudomonas aeruginosa), for the identification of which additional bacteriological studies should be used;
• generalization of infection, i.e. sepsis.

As a rule, staphylococcal infection is accompanied by vivid clinical manifestations of the wound process, streptococcal infection is sluggish, Pseudomonas aeruginosa is characterized by severe intoxication, and anaerobic (putrefactive) flora is characterized by rapid spread of the process to surrounding tissues, the absence of signs of demarcation with scanty local manifestations.

In case of reverse discrepancy (weak general reaction in patients with extensive wound infection), the possibility of hypo- and areactive reactions in patients with immunosuppression should be kept in mind.

Changes in the body's immune resistance and the use of massive antibacterial therapy can lead to atypical manifestations of wound infection, when local and general changes are expressed insignificantly with an extensive purulent process. These conditions are no less dangerous, since a breakdown of adaptation mechanisms and generalization of infection are possible.

Diagnosis is based primarily on clinical signs of wound infection, which allow not only to assess the nature and severity of the wound process (during wound revision), but also to suggest the type of pathogen.

Wound infections also include suppurating hematomas of the anterior abdominal wall and perineum.

Causes - violation of surgical technique (hemostasis defects) or interventions against the background of DIC syndrome in severe patients. Extensive subaponeurotic hematomas are the most severe and are recognized late. They are more common after Pfannenstiel laparotomy, when the aponeurosis is separated from the muscles over a large area, less common - with lower median laparotomy. In the presence of hematomas, patients are bothered almost immediately after the operation by pressing or bursting pains in the suture area, which at first, as a rule, are mistaken for ordinary postoperative pains, relieved by the administration of narcotic drugs.

The detection of moderate and sometimes severe anemia is also more often regarded as intraoperative blood loss.

Only suppuration of the hematoma and the addition of signs of infection allows us to make a correct diagnosis.