A 46-year-old woman has been hospitalized with open fracture of the left thigh in its middle third. She underwent the surgery – fixation with extraosseous osteosynthesis plates. On the 4th day after the surgery she developed pain in the wound, body temperature rose over 39°C. What measures should be taken in this case?

Answer options

1. Remove the fixation, prescribe sulfanilamides
2. Administer antibiotics intraosseously and hypothermia locally
3. Inject antibiotics into the area surrounding the wound, prescribe spasmolytics and analgesics
4. Prescribe broad spectrum antibiotics and hormonal agents
5. Undo the sutures, drain the wound, and prescribe antibiotics

Explanation

A major SSI is defined as a wound that either discharges significant quantities of pus spontaneously or needs a secondary procedure to drain it. The patient may have systemic signs such as tachycardia, pyrexia, and a raised white cell count. Minor wound infections may discharge pus or infected serous fluid but are not associated with excessive discomfort, systemic signs, or delay in return home. The differentiation between major and minor and the definition of SSI is important in audits and clinical trials of antibiotic prophylaxis. If an infected wound is under tension, or there is unmistakable evidence of suppuration, sutures or clips need to be removed, with curettage if necessary, to allow pus to drain adequately. In severely contaminated wounds, such as an incision made for the drainage of an abscess, it is logical to leave the skin open. Delayed primary or secondary closure can be undertaken when the wound is clean and granulating. Some heavily infected wounds may be left to heal by secondary intention, with no attempt at closure, particularly where there is a loss of skin cover and healthy granulation tissue develops. While the result may be excessive scarring, that can always be revised with plastic surgery under clean surgical conditions at a later stage. Risk factors for increased risk of wound infection Malnutrition (obesity, weight loss) Metabolic disease (diabetes, uremia, jaundice) Immunosuppression (cancer, AIDS, steroids, chemotherapy, and radiotherapy) Colonization and translocation in the gastrointestinal tract Poor perfusion (systemic shock or local ischemia)Foreign body material Poor surgical technique (dead space, hematoma) Bailey & Love’s short practice of surgery. – 27th edition. – P. 42.