The document discusses various types of surgical site infections and soft tissue infections. It defines surgical site infection and classifies them as major or minor. It describes different clinical presentations of infections such as boils, carbuncles, cellulitis, erysipelas, and abscesses. It provides details on pathogenesis, clinical features, complications, and treatment approaches for each of these conditions. The document is a guide for physicians on proper diagnosis and management of common post-surgical and soft tissue infections.

1. Dr Hamid Rahman Sabawoon 1

2. Prepared and presented by: Dr Hamid
Rahman Sabawoon, MD, LMIH,MN,
Supervised by: Dr Mirwais Jalal, MD,
Trainer of G.Surgery
‫افغانســــــــتان‬ ‫اســـــــالمی‬ ‫جمــــــــــهوری‬
‫عـــــــــــــــامه‬ ‫صحـــــت‬ ‫وزارت‬
‫تخــــصـــــص‬ ‫اکمــــــــــال‬ ‫ریاســــت‬
‫بلــــــخی‬ ‫رابعـــــــه‬ ‫کمپــــلکس‬ ‫شفـــــاخانه‬
‫عمــــــومی‬ ‫جــــــراحی‬ ‫دیپــــــارتمنـــت‬

3. Surgical Infection

4. A Public Health Approach
Surveillance
Risk Factor
Identification
Intervention
Evaluation
Implementation
4

5. Illness, Sickness, and
Disease
 illness’ to refer to the subjective
sense of feeling unwell;
 illness does not define a specific
pathology, but refers to a person’s
subjective experience of it, such as
discomfort, tiredness, or general
malaise.
 The way a patient reports symptoms is
influenced by his or her cultural
background,

6.  Sickness’ to refer to socially and
culturally held conceptions of health
conditions (e.g., the dread of cancer or
the stigma of mental illness), which in
turn influence how the patient reacts
 Disease’ implies a focus on
pathological processes that may or
may not produce symptoms and that
result in a patient’s illness.

7. Superficial soft tissue
suppurative infection

8. Surgical site infection
Definition: infection in surgical site.
Classification l:
Classification ll:
Major SSI Minor SSI
Significant quantity of pus Small purulent or serous discharge
Delayed return home No delayed return home
SIRS i.e. tachycardia, pyrexia, leukocytosis No SIRS
Superficial Skin and subcutaneous tissue
Deep Musculofacial layers
Organ/space infection e.g. Intra-abdominal

9. SSI
 SIRS(Systemic inflammatory Response
syndrome)
 It’s a body response to SSI
features
Hyperthermia >38’c
Hypothermia <36’c
Tachycardia >90/min
Bradycardia <20/min
WBC count >12000 or <4000

10. SSI
 Sepsis= SIRS + infection
 Severe Sepsis= Sepsis + with one or more
organ failure.
 MODS(Multiple Organ Dysfunction Syndrome)
 It’s the effectthat the infection produces
systemically
 MSOF(Multiple System Organ Failure)
 It’s the end-stage of uncontrolled MODS

11. Step-ladder of SSI leading to death
Surgical procedure
SSI
SIRS
Sepsis
Severe Sepsis
MODS
MSOF
Graveyard

12. Furuncle (boil)
 Is a staphylococcal infection of a hair follicle or a
sebaceous gland.
 Pathology: acute suppurative inflammation
 Furunculosis: infection of several hair
follicles in a circumscribed area.
 The common sites:
face, neck and axilla.

13. Boil (Furuncles)

14. Clinical Picture
A small painful indurated swelling which is
- red
- hot
- and very tender
Common in diabetics.

15. Boil (Furuncles)

16. Complications
 boil may lead to cellulitis, particularly in those whose
power of immunity is less.
 boils may also lead to infection of the neighboring
hair follicles where numbers of hair follicles are too
many (e.g. axilla) leading to hydradenitis.
 boils usually secondarily infect the regional lymph
nodes.
 Cavernous sinus thrombosis if boil is on the face and
infection spreads through veins to intracranial
cavernous sinuses.

17. Treatment
 1.Antibiotics.
 2.Antiseptic.

18. Treatment
 The general health of the patient has to be improved, as boils
often occur in individuals with debility and ill-health.
 Incision is usually unnecessary as the pustule is very small.
Only a touch of iodine on the skin pustule will hasten necrosis
of the overlying skin and help the pus to drain out.
 If escape of pus does not occur spontaneously or with
application of iodine, removal of the affected hair allows
ready escape of pus.
 Antibiotic is usually not required.
 After escape of pus this placet should be cleaned twice with a
suitable disinfectant e.g. hexachlorophene.
 Analgesics (painkillers)

20. Carbuncle
 Is infective gangrene
of the subcutaneous
tissues usually secondary
to infection by
Staphylococcus aureus.
 It is common in immunocompromised
patients as in diabetics.
 The common sites:
face, nape of the neck, and the back

21. Pathology
 Infection usually starts in a hair follicle
 Extends to the subcutaneous fat where other
hair follicles get the infection.
 Multiple areas of necrosis and thrombosis of
blood vessels occur.
 Patches of skin undergo sloughing and
separate from the underlying granulation
tissue

22. Carbuncle

23. Clinical Picture
 There is usually sever toxemia.
 Starts as a painful induration of the skin and
subcutaneous tissues.
 The skin is red.
 Swelling its central part becomes soft.
 Multiple areas of skin thin out and separate
forming multiple sinuses.

24. Complications
 Local spread of infection.
 Pyaemia and septicemia.
 Cavernous sinus thrombosis
 Epidural abscess or meningitis

25. Antrax Carbuncle

26. Treatment
 improvement of the general health of the patient
should be brought about.
 proper antibiotic should be started immediately
from the culture and sensitivity test.
Operation may be required:
1. when toxaemia and pain persist even after a course
of antibiotics.
2. when the carbuncle is more than 2 inches in
diameter. It must be remembered that incision is
never made unless there is softening in the centre.

27. Treatment
1.Antibiotics.
2.culture and sensitivity of the discharge.
3.control of diabetes.
4.surgical excision of sloughs.

29. Hydradenitis Suppurativa
Mixed staph. And streptococcal infection
of the apocrine sweat glands, in the
perineum or the axilla,produces multiple
abscesses and pus discharging sinuses.

30. Hiradenitis

31. Treatment
 Surgical drainage of abscesses.
 Antiseptic and antifungal applications.
 Surgical excision of the apocrine sweat-
bearing skin following by skin grafting is
essential.

32. Cellulitis
 Is an invasive non suppurative infection of
the loose connective tissue
 Organism :
 streptococci [common]
 staphylococci [occasionally]
 Mix
 Anaerobic cellulites: crepitation

33. Clinical picture
 The affected area is red,indurated,hot and
painful
 It spreads rapidly with ill defined edge
 The skin may be the seat of blisters
 Fever
 Lymphangitis in the form of red streaks
 No suppuration
 In severe cases patches of skin necrosis with
sloughing of subcutaneous tissues

35. Differential Diagnosis
 Contact allergy
 Chemical inflammation
 DVT 4 “Nos”
No edge No pus
No Fluctuation No limit

36. Treatment
I. Bandaging to support the area
II. Rest and elevation of the affected part
III. Antibiotic (penicillin iv )
IV. Analgesics (painkillers)

37. Erysipelas
Skin wound local inflammation
lymphadenitis systemic inflammation
Redness of skin with clear boundary
Edema of proximal lymph node
Systemic sepsis

39. Clinical Picture
 Toxemia
 Locally : similar to cellulitis, but there
are the following differences:
1. The color of the skin is rose-pink
2. The edge is well defined
3. There may islets of inflammation beyond the
spreading margin

40. Complications
 1. Facial erysipelas may lead to cavernous
sinus thrombosis
 2. Septicemia
 3. Recurrent erysipelas may block the
lymphatics leading to elephantiasis.

41. Erysipelas

42. Treatment
 Isolation
 Similar to cellulitis

43. Erysipelas

44. Abscess
 Characterized by a necrotic center without a blood
supply and composed of debris from local tissues,
dead and dying leukocytes, components of blood
and plasma and bacteria.
 Avenues
 Direct spread :micro-organism get entry through
some breach in the surface epithelium.
 Lymphatic spread :from some distant focus
 Hematogenous spread:from some distant focus.

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

47. Abscess
 Types
1. Pyogenic abscess
2. Pyaemic abscess
3. Cold abscess

48. Abscess
Pyogenic abscess:
Pain: throbbing in character
Fever: swinging rise of body temperature with or
without shivering.
Area is red, hot, smooth, soft and tender
Brawny induration and oedema(pitting on pressure)
Flactuation is present
Regional lymph nodes maybe enlarged and tender

49. Abscess
Pyaemic abscess:
 Generally multiple
 Maybe synchronous(occurring at the same time) or
metachronous(in succation one after the other)
 Pyeamia is present(infective emboli in the blood)
 Non-reacting in nature.ie local features are absent
 Flactuation will be present
 Constitutional disturbances are great e.g pyrexi,
rigors,tachycardia and sweating.

50. Abscess
 Cold abscess:
 Its always a sequel of tuberculosis infection(caseation
necrosis) commonly seen in lymph node, joints and bone
 Non-reacting in nature
 Fluctuation is present
 Common site are:
 Neck and axilla-tuberculos lymphadenitis
 Right/left iliac fossa-tuberculosis of spine
 Bones- tuberculous osteomyelitis
 Joints- tuberculous arthritis
 Lion- tuberculous pyonephrosis

51. Abscess

52. Treatment
The basic principle of treatment of an abscess are:
 to drain the pus;
 to send a sample of pus for culture and
sensitivity test;
 Surgical decompression by incision/drainage,
curettage or finger breaking of loculi followed
by daily antiseptic dressing
 to give proper antibiotic.
 To give proper Analgesic for pain control

53. Acute Lymphangitis and
Lyphadenitis
 Acute lymphangitis:is due to infection of
lymph vessels by organisms usually
streptococci.
 Acute lymphadenitis: is due to spread of
infection along lymphatics from a septic
focus in the drainage area to the lymph-
nodes.

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

55. Lymphangitis

56. Treatment
 Antibiotics.
 Hot applications.
 Surgical drainage if suppuration
occurs.

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

58. Paraproctitis
 is the purulent inflammation of around-
rectal cellular tissue.

59. Paraproctitis

60. Perirectal abscess

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

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

63. Acute suppurative
infection
of the hand

64. paronychia
lateral nail fold trauma redness, pain
suppurative infection
Treatment:
 incision and drainage
 removal of the nail: infection extend
deep to the nail
 antibiotics

66. felon
paronychia spread or
penetration wound
causes: pain fever
WBC elevation
Treatment:
 incision and drainage
 antibiotics

68. Gas gangrene