Dr. Nawaz Dal Plast & Recons & wound infec.pptxDr. Nawaz Dal Plast & Recons & wound infec.pptxDr. Nawaz Dal Plast & Recons & wound infec.pptxDr. Nawaz Dal Plast & Recons & wound infec.pptxDr. Nawaz Dal Plast & Recons & wound infec.pptxDr. Nawaz Dal Plast & Recons & wound infec.pptxDr. Nawaz Dal Plast & Recons & wound infec.pptxDr. Nawaz Dal Plast & Recons & wound infec.pptxDr. Nawaz Dal Plast & Recons & wound infec.pptxDr. Nawaz Dal Plast & Recons & wound infec.pptx

1. PLASTIC SURGERY AND
RECONSTRUCTIVE SURGERY AND
WOUND INFECTION
DR. NAWAZ ALI DAL
FCPS
DEPARTMENT OF SURGERY
SURGICAL UNIT-II WARD-12
LUMHS, JAMSHORO

3. History
• It produced the two “fathers” of modern plastic
surgery, New Zealander Harold Gillies and American
Vilray Blair.
• Gillies even performed the first male-to-female sex
change operation in 1951!
Gillies Blair

29. Wound Infections

31. Wound Infections
• Penetration of the skin by micro-organisms is
difficult—Part of the innate defense
• Disease production in infected wounds depends on
– How virulent infecting organisms are
– How many organisms infect the wound
– Nature of the wound
• Does it contain crushed material or foreign material

32. Staphylococcal Wound Infections
• Leading cause of wound
infections
• Symptoms
– Bacteria are pyogenic
– Infection causes
• Inflammation
• Fever
– Some strains produce
toxic shock syndrome

33. Staphylococcal Wound Infections
 Causative Agent: S. aureus
• Virulence due to the production of extracellular
products
– Coagulase
» Causes blood clotting to evade phagocytosis
– Clumping factor
» Aids in bacterial wound colonization
– Protein A
» Hide bacteria from phagocytic cells
–  toxin

34. Staphylococcal Wound Infections
• Treatment
– Many strains develop resistance to antibiotics
• Many strains treated with anti β lactamase penicillins and
vancomycin
• Epidemiology
• 30% to 100% due to patient’s own flora
– Factors associated with infection include
• Advanced age
• Immunosupression or poor general health
• Prolonged postoperative hospital stay

35. Group A Streptococcal Infections
• Primary pathogen is S. pyogenes
– Β hemolytic, Gram-positive cocci in chains
– Can cause rapidly deteriorating disease and death
• Common cause of wound infections
– Not a lot of antimicrobial resistance: early penicillin

36. Pseudomonas aeruginosa Infections
• P. aeruginosa
• Major cause of nosocomial
infections
– Lung infections
– Burn infections
• Community acquired infections
include
– Rash and external ear infections
– Infection of foot bones
– Eye infections
– Heart valve infections
– Lung biofilms

37. Pseudomonas aeruginosa Infections
 Pathogenesis
› Some strains produce enzymes and toxins to enhance virulence
• Epidemiology
– P. aeruginosa is widespread in nature
• Prevention and Treatment
– Prevention involves elimination of sources of bacteria
– P. aeruginosa is multi-drug resistant
– Medications must be administered intravenously at high
doses

38. Tetanus (Lockjaw)
• Symptoms
– Divided into early and late symptoms
– Early symptoms
• Restlessness
• Irritability
• Difficulty swallowing
• Contraction of jaw muscles
• Convulsions
– Later symptoms
• Increased muscle involvement
• Pain
• Difficulty breathing
• Death

39. Tetanus
• Causative Agent
– Clostridium tetini
• Anaerobic
• Gram-negative
• Bacillus
• Spore former
 25% mortality rate; rare in the developed world
– tetanospasmin toxin
• blocks inhibition of motor neurons, causing paralysis
• Prevention: vaccination, treatment: antitoxin
 Bacterial spores prevalent in dirt and dust and gastro
intestinal tract of humans and other animals

40. Clostridial Myonecrosis (Gas
Gangrene)
• Causative Agent
– Several species of Clostridium
• Most common offender, C. perfrigens
• Encapsulated, Gram-negative bacillus
• Endospores of causative bacillus
• Spores found in nearly all soil or dusty surface
– Normal flora of intestinal tract and vagina
• Primarily disease of wartime
– Due to neglected wounds containing debris
– Treat with hyperbaric oxygen, antibiotics (penicillin)

41. Actinomycosis
• Causative Agent
– Actinomyces israelii
• Pathogenesis
– A. israelii cannot penetrate healthy mucosa
– Infection is characterized by cycles
• Abscess formation → scarring → formation of sinus tracts
– Disease progresses to skin and can penetrate bone or central nervous
system
• Epidemiology
– Can be normal flora
• Prevention and Treatment
– No proven prevention
– Responds to numerous antibacterials
• Penicillin and tetracycline

42. Pasteurella multocida
• Causative Agent
– Pasteurella multocida
• Gram-negative
• Coccobacillus
• Most are encapsulated
• Bite infections from numerous animals
– Fowl Cholera, animal reservoir
• Symptoms
– Spreading redness
– Tenderness
– Swelling of adjacent tissues
– Pus discharge

43. Cat Scratch Disease
• Causative Agent
– Bartonella henselae
• Gram-negative bacillus
• Symptoms
– Disease begins within a week
– Painful enlargement of lymph nodes
– Fever
• Epidemiology
• Cats infected by flea
bite
– Infections treated
with amipicillin

44. Streptobacillary Rat Bite Fever
• Causative Agent
– Streptobacillus moniliformis
• Gram-negative,Bacillus
• Symptoms
– Bite wound usually heals without complication
– Development of chills, fever, head and muscle ache and vomiting 2 to
10 days after healing
• Majority of cases are self limiting
• 7% - 10% of untreated cases are fatal

45. Sporotrichosis:
AKA. “rose gardener’s disease”
• Causative Agent
– Sporothrix schenckii
• Lives in soil and on vegetation
• Associated with puncture wound from
vegetation
• Sporadic:
– rare in healthy people
– Untreated cases may become chronic
– Itroconazole and amphotericin B

46. THANKS FOR ATTENTION