Intercostal drainage tube insertion is an emergency as well as planned procedure. In emergency it is a one of the life saving procedures. That's why it is important to learn the anatomy and physiology behind insertion of ICD and what should be the ideal procedure and post procedure care.
Intercostal drainage tube insertion is an emergency as well as planned procedure. In emergency it is a one of the life saving procedures. That's why it is important to learn the anatomy and physiology behind insertion of ICD and what should be the ideal procedure and post procedure care.
Principles of surgery. Day case surgery is a rapidly evolving surgical sub speciality that seeks to eliminate the need for prolonged admission in surgical patients and the attendant complications of prolonged immobilization. It is based on the documented evidence that most post op patients does not require specialised post op care and hence can be allowed to recover at home. This form of surgery appeals to patients and their families due to the fact that it allows only minimal interruption of patient's social life
LAPAROSCOPIC CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparoscopiccholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and Open Cholecystectomy.
• In this video today, I have discussed Laparoscopic Cholecystectomy- the flagship procedure for laparoscopic surgeries.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and the links are:
• https://www.youtube.com/watch?v=VStEzI1jL8Y
• https://www.youtube.com/watch?v=O8j4kwpzd24
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
Management of post operative wound infectionBashir BnYunus
post operative wound infection now surgical site infection is a common post operative complication especially in developing countries and the 2nd most common nosocomial infection. it leads to prolong hospital stay among other complications
Principles of surgery. Day case surgery is a rapidly evolving surgical sub speciality that seeks to eliminate the need for prolonged admission in surgical patients and the attendant complications of prolonged immobilization. It is based on the documented evidence that most post op patients does not require specialised post op care and hence can be allowed to recover at home. This form of surgery appeals to patients and their families due to the fact that it allows only minimal interruption of patient's social life
LAPAROSCOPIC CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparoscopiccholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and Open Cholecystectomy.
• In this video today, I have discussed Laparoscopic Cholecystectomy- the flagship procedure for laparoscopic surgeries.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and the links are:
• https://www.youtube.com/watch?v=VStEzI1jL8Y
• https://www.youtube.com/watch?v=O8j4kwpzd24
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
Management of post operative wound infectionBashir BnYunus
post operative wound infection now surgical site infection is a common post operative complication especially in developing countries and the 2nd most common nosocomial infection. it leads to prolong hospital stay among other complications
Surgical site Infection during Internship in medical college.pptxrautkrisna
Infections that occur in the wound created by an invasive surgical procedure are generally referred to as surgical site infections (SSIs). SSIs are one of the most important causes of healthcare-associated infections (HCAIs). A prevalence survey undertaken in 2006 suggested that approximately 8% of patients in hospital in the UK have an HCAI. SSIs accounted for 14% of these infections and nearly 5% of patients who had undergone a surgical procedure were found to have developed an SSI. However, prevalence studies tend to underestimate SSI because many of these infections occur after the patient has been discharged from hospital. SSIs are associated with considerable morbidity and it has been reported that over one-third of postoperative deaths are related, at least in part, to SSI. However, it is important to recognise that SSIs can range from a relatively trivial wound discharge with no other complications to a life-threatening condition. Other clinical outcomes of SSIs include poor scars that are cosmetically unacceptable, such as those that are spreading, hypertrophic or keloid, persistent pain and itching, restriction of movement, particularly when over joints, and a significant impact on emotional wellbeing. SSI can double the length of time a patient stays in hospital and thereby increase the costs of health care. Additional costs attributable to SSI of between 814 and 6626 have been reported depending on the type of surgery and the severity of the infection. The main additional costs are related to re-operation, extra nursing care and interventions, and drug treatment costs. The indirect costs, due to loss of productivity, patient dissatisfaction and litigation, and reduced quality of life, have been studied less extensively.Infections that occur in the wound created by an invasive surgical procedure are generally referred to as surgical site infections (SSIs). SSIs are one of the most important causes of healthcare-associated infections (HCAIs). A prevalence survey undertaken in 2006 suggested that approximately 8% of patients in hospital in the UK have an HCAI. SSIs accounted for 14% of these infections and nearly 5% of patients who had undergone a surgical procedure were found to have developed an SSI. However, prevalence studies tend to underestimate SSI because many of these infections occur after the patient has been discharged from hospital. SSIs are associated with considerable morbidity and it has been reported that over one-third of postoperative deaths are related, at least in part, to SSI. However, it is important to recognise that SSIs can range from a relatively trivial wound discharge with no other complications to a life-threatening condition. Other clinical outcomes of SSIs include poor scars that are cosmetically unacceptable, such as those that are spreading, hypertrophic or keloid, persistent pain and itching, restriction of movement, particularly when over joints, and a significant impact on emotional wllbeing
Prevention of Surgical Site Infection- SSI [compatibility mode]drnahla
Infection Control Guidelines for Prevention of Surgical Site Infection- SSI
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.
Infectious Diseases HighYield and Frequently tested concepts on USMLE Step 3. These slides are samples from Archer USMLE Step 3 Review Lectures. Couple it with Archer Step 3 Question bank and Step 3 CCS to easily pass your final part of USMLE licensing exams
A discussion on the risk factors, classification and clinical presentation of surgical site infection. Also elucidates the overview of management approach to SSI.
his topic - Intestinal Obstruction is very important for final year MBBS - Students & the Medical Officers, as it is one of the commonest causes of Acute Aabdomen. The PPT - contains the classification, common causes, clinical features & management aspects of Intestinal Obstruction. Also, highlights the differentiating features of Plain X-ray abdomen of Small & Large Bowel Obstruction.
This topic is very important for an MBBS Students as it is one of the common cases a Medical Officer will come across during their Surgical Postings. Moreover it is always a Debate in treating the patient either an Physician or a Surgeon...Always it is one of the Devastating conditions of abdomen...
This topic comes under the category - Venous Diseases. It is very important for a 3rd year MBBS Student to know about Varicose Veins, which is one of the commonest diseases encountered among out-patients.
This topic is under the Chapter - Arterial Disorders. The MBBS Students should know the types of Aneurysms and particularly Abdominal Aortic Aneurysms.
This topic covers the etiology, types, pathogenesis and management of Hypovolemic & Septic Shock. It is very important for MBBS Students both theoritical and clinical aspect. Also they should know the hemodynamics of the above both types of Shock.....
This topic is under the Arterial Diseases of the Limbs. The MBBS students should know the Classification and Pathogenesis of Diabetic Foot. Also the different types of Gangrene and difference between Dry & Wet Gangrene....
This topic is under the category of Arterial Diseases. One of the subtopic is CLI. One of the ommon causes for CLI, is Atherosclerosis, which is discussed in this PPT.
This topic is under the category of Arterial Diseases. It is very important for an MBBS students to know about ALI, so as to treat them initially and then refer them to vascuar surgeons.
This topic is under the General Principles of Surgery. It is very important for MBBS - Students. New method of resuscitation called the Damaged Control Resuscitation is carried out in controlling the hemorrhage.
This topic covers the etiology, types, pathogenesis and management of Shock. It is very important for MBBS Students both theoretical & clinical aspect. Also they should know the hemodynamics across the types of shock in treating the patients....
This topic is under the General Principles of Surgery for MBBS Students. It also deals with Scars & Contractures. The student should know to differentiate between Hypertrophic Scar & Keloid..
This topic is mainly for MBBS Studnts. It is under the General Principles of Surgery. Students shoud know the phases of wound healing so as to treat them appropriately and select the correct method of dressing material....
This topic comes under the General Principles of Surgery for MBBS Students. The student should know the various types of wounds, their assessment and dressing methods.
IBD is very important topic even though the disease is prevalent in western countries. This PPT covers both the diseases side by side for comparing at same time and having an idea about them all together.
This topic is very important in day - today practice. Mainly this topic can be kept in clinical cases as well as OSCE's. for Final MBBS - Students. This PPT covers most of them in detail as far as possible.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. Introduction
Surgical infection is major problem in surgical practice.
In 1992, the US Centers for Disease Control (CDC) revised its
definition of 'wound infection', creating the definition 'surgical site
infection' (SSI) to prevent confusion between the infection of a
surgical incision and the infection of a traumatic wound.
Accounts for 15-25% of all surgical infections & increased cost to
healthcare.
3. Definition
The infection of a wound can
be defined as the invasion of
organisms through tissues
following a breakdown of local
& systemic host defences
leading to local & systemic
presentation.
5. Important Definitions
SSI
Is an infected incised wound or deep organ space.
SIRS
Is the body’s systemic response to an infected wound.
MODS
Is the effect that the infection produces systemically.
MSOF
Is the end-stage of uncontrolled MODS.
6. Important Definitions
SIRS – Any 2
Hyperthermia (> 38°C) or Hypothermia (< 36°C)
Tachycardia (> 90/min) or Tachypnoea (> 20/min)
WBC > 12 × 10 99 / l or < 4 × 10 9 / l
SEPSIS
Is SIRS with a documented infection.
SEPSIS SYNDROME
Is sepsis with evidence of one or more organ failures.
9. Factors - Determine
Host response
Virulence
Vasculature & Health of tissue
Presence of dead / foreign tissue
Presence of antibiotic – “decisive
10. SSI – Assessment
For surgical wound assessment several scoring systems are employed
ASEPSIS wound score
Southampton wound grading system
These enable surgical wound healing to be graded according to specific
criteria, usually giving a numerical value, thus providing more objective
assessment of wound.
16. Depth - Deep Incisional SSI
Occurs - 30days – 1yr
Deep soft tissue
Purulent discharge – not from organ
Spont.opened or delibe.opened
Deep abscess – by re-op/histo/X-ray
Opened & diagnosed - surgeon
17.
18. Depth - Organ / Space SSI
Occurs - 30days – 1yr
Involves – any part [organ/space]
Purulent discharge – drain
Organisms – isolated
Deep abscess – direct & re-op /
histology / X-ray
Opened & diagnosed - surgeon
19.
20. Further classification
Etiology
Time Severity
Primary:
Acquired from a community
or endogenous source (such as
that following a perforated peptic
ulcer).
Secondary or exogenous
(HCAI): Acquired from the OT
(such as inadequate air filtration)
or Ward (e.g. poor hand-washing
compliance) or from contam. at or
after surgery ( anastomotic leak ).
Early
Infection presents
within 30 days of
procedure.
Intermediate
Occurs between 1 –
3 months.
Late
Presents > 3
months after surgery.
Minor
Wound infections may discharge pus
or infected serous fluid but should not
be associated with excessive
discomfort, systemic signs or delay in
return home.
Major
A major SSI is defined as a wound
that either discharges significant
quantities of pus spontaneously or
needs a secondary procedure to drain it.
21.
22. Surgical site prevention
Antibiotics & Prophylaxis
appropriately
Operation Theatre
procedures
Maintain normal
BG / BT
Post- op care
Pre- operative measures
23. Pre-operative
Staff should always wash their hands - pts.
Length of patient stay should be kept to a min.
Preop. shaving should be avoided if possible.
Antiseptic skin prepn. should be standardized.
Attention to theatre technique & discipline.
Avoid hypothermia perioperatively & ensure
supplemental O2 in recovery.
25. Principles – Antibiotic therapy
Antibiotics do not replace
surgical drainage of
infection.
Only spreading infection or
signs of systemic infection
justifies the use of
antibiotics.
26. Antibiotic therapy - Approach
A narrow-spectrum antibiotic may be
used to treat a known sensitive infection.
Combinations of broad-spectrum
antibiotics can be used when the
organism is not known or when it is
suspected that several bacteria, acting in
synergy, may be responsible for the
infection.
New antibiotics should be used with
caution & wherever possible, sensitivities
should first be obtained.
27. Prophylaxis – Choice of antibiotics
Empirical cover against expected pathogens
with local hospital guidelines.
Single-shot I. V administration at induction of
anaesthesia.
Repeat only in prosthetic surgery, long
operations or if there is excessive blood loss.
Continue as therapy if there is unexpected
contamination.
Pts. with heart valve disease or a prosthesis
should be protected from bacteraemia caused by
dental work, urethral instrumentation or visceral
surgery.
28. Regimes – Operations
Type of Surgery Organisms involved Prophylactic regime
Vascular Staphylococcus epidermidis (or
MRCNS)
Staphylococcus aureus (or MRSA)
Aerobic Gram-negative bacilli (AGNB)
3 doses of flucloxacillin with or without
gentamicin, vancomycin or rifampicin
if MRCNS / MRSA a risk
Orthopedic Staphylococcus epidermidis / aureus 1 -3 doses of a broad-spectrum
cephalosporin or gentamicin
Oesophagogastric Enterobacteriaceae / Enterococci 1 3 doses of a second-generation
cephalosporin & metronidazole in
severe contamination
Biliary Enterobacteriaceae / Enterococci 1 dose of a second-generation
cephalosporin
Small bowel Enterobacteriaceae / Anaerobes 1 – 3 doses of a second-generation
cephalosporin with or without
metronidazole
Appendix / Colorectal Enterobacteriaceae / Anaerobes 3 doses of a second-generation
cephalosporin (or gentamicin)
with metronidazole
29. Treatment
Mgt - depend on type of SSI
Surgical debridement of wound
Suture – removed – free drainage
Fluid – C/S – Suitable antibiotics
Signs of healing – sec. suturing
31. “Attack the problem, not the Person”
Penicillins- Penicillin G, Piperacillin
Penicillins with β-lactamase
inhibitors- Tazocin
Cephalosporins (I, II, III)-
Cephalexin, Cefuroxime, Ceftriaxone
Carbapenems- Imipenem, Meropenem
Aminoglycosides- Gentamycin,
Amikacin
Fluoroquinolones- Ciprofloxacin
Glycopeptides- Vancomycin
Macrolides- Erythromycin,
Clarithromycin
Tetracyclines- Minocycline,
Doxycycline
Editor's Notes
Inoculation of the surgical sites occurs during surgery either inward from the skin or outward from the internal organ being operated upon, the microbiology of SSI depends on the type of operation being performed .
Most SSI are caused by gram positive bacteria , organisms are part are skin derived. Increased likelihood of infection by gram negative bacilli after gastrointestinal surgery.
With surgery of the head and neck when pharyngeoesophygeal structure are opened anaerobic bacteria may cause SSI