Wound infection in gynecology

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

According to the classification of MI Kuzin (1977), the course of the wound process is divided into phases:

I phase - inflammation:

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

In uncomplicated course, the I phase lasts 3-5 days. On examination, there is a slight soreness, swelling and hyperemia of the edges of the wound, there is a close contact of its edges. Detachable from the wound there.

II phase - regeneration: the appearance of granulations (brilliant fine-grained pink or crimson colored formations, abundantly bleeding). The granulation barrier prevents the introduction of infection into the wound. In uncomplicated course, phase II is completed by the 8th-10th day of the formation of a narrow linear cutaneous scar.

III phase - reorganization of the cicatrix and epithelization: the wound is completely made by granulations, concentrically reduced.

Conditions for wound healing by primary tension:

• contact of the edges of the wound (diastase no more than 10 mm);
• preservation of tissue vitality;
• absence of hematoma and foci of necrosis;
• aseptic.

The main pathogens of wound infection are currently Gram-positive aerobic cocci - Staphylococcus aureus (up to 90% of the entire wound infection), other types of staphylococci, as well as streptococci; Gram-negative aerobic flora (intestinal and pseudomonas aeruginosa) is 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 (intestinal and Pseudomonas aeruginosa) is more often identified.

Wound infection - Causes and pathogenesis

More often the suppuration of a wound occurs on the 5th-8th day after the operation.

The following are clinical signs of wound suppuration.

1. Occurrence of local signs of infection:
   • the presence of pain in the wound area, which usually have an increasing character (initially constant pressing, then "pulling" or pulsating) and decrease only after treatment or drainage of the wound or in case of spontaneous appearance of a wound detachable;
   • the appearance of hyperemia and edema in the area of the wound (suture);
   • divergence of the edges of the wound, appearance of serous or purulent discharge;
   • local hyperthermia.

Wound infection - Symptoms

The leading method for diagnosing wound infection is clinical. Inspection and sounding of the wound: with an infection located in the cellulose, the leading signs are infiltration and tenderness of the suture, with suppuration, there is skin hyperemia and areas of fluctuations. With hematomas of subcutaneous tissue, there is usually an imbibition of the skin with blood in the appropriate area. The diagnosis is easily confirmed by dilution of the edges of the cutaneous wound.

Wound infection - Diagnosis

Tactics of management of patients with wound infection. There are different views on managing patients with wound infection. The discrepancy is mainly related to 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 with perforated polyvinyl chloride drainage and prolonged washing with antiseptics;
• as early as possible closure of the wound with the help of primary, primary delayed, early secondary sutures or skin plasty;
• general and local antibiotic therapy;
• increase of specific and nonspecific reactivity of the organism.

Wound infection - Treatment