At influence of adverse environmental conditions or excessively strong irritants, the reaction develops in the organism which breaks interrelation of physiological function and on this basis, a new condition called illness develops. It is necessary to relate to harmful agents of our environment who can cause such reactions virulent, pathogenic microorganisms.
Depending on the principle which underlies, surgical infection is divided into various groups. So, at the accounting of clinical process and pathomorphological changes in fabrics of all types of surgical infection, we distinguish sharp and chronic forms.
- Sharp surgical infection:
- Sharp purulent infection
- Sharp putrefactive infection
- Sharp specific infection (tetanus, anthrax, gas gangrene, etc.)
- Chronic surgical infection:
- Chronic nonspecific infection
- Chronic specific infection.
Depending on the prevalence of local or general symptoms at any of specified nosologic forms there can be a local surgical infection and general surgical infection (sepsis). The purulent infection has the greatest specific weight among all surgical infections. This group of diseases is divided:
- According to clinical process:
- Sharp purulent infection: general, local
- Chronic purulent infection: general local
- According to location:
- skin and hypodermic cellulose
- integuments of the skull, the brain, and its integuments
- the chest wall, the pleural cavity, the lungs
- Mediastinum (mediastinitis, pericarditis)
- peritoneum and abdominal organs
- bodies of a basin
- bones and joints
- According to etiology.
- Staphylococcal infection
- Streptococcal infection
- Pneumococcal infection
- Colibacillosis infection
- Gonorrheal infection
- mixed infection
Ways of introduction and distribution of microbes are of great importance for the development of the purulent process. It is well-known that microbes should get through the damaged epithelium of skin and mucous membranes into internal environment of the organism for the development of a purulent disease. Undamaged skin and mucous are a quite often insuperable barrier to micro flora. The amounts of damage of covers are indecisive for that how microorganisms get into the internal environment through big and micro injured areas of covers of the body. Let’s track the way of introduction and distribution of microbes. They get to intercellular cracks, lymphatic vessels through defect of the epithelium and are brought with the flow of the lymph in deeply situated fabrics (skin, hypodermic cellulose, muscles, lymph nodes, internal etc.). This process gains considerable distribution at a big dose of virulent microbes and weakness of protective forces of the organism can become general. Local conditions influence the development of an infection.
Microorganisms encounter considerable resistance in the bodies which have a well-developed network of blood vessels and good blood supply. So, purulent processes develop on the head and the face more seldom than in other areas.
During the first 6 hours, a microbe adapts in the wound to the new biological environment. Moments which are favorable to the development of microbes are considered:
- Existence of traumas, nutrient medium (hemorrhage, dead cells, and fabrics) in the zone,
- Penetration of several species of microbes (poly infection) which possess synergistic action,
- Penetration of microbes of raised virulence, for example, pollution of injury by the discharge of the wounds of the other patient.
Microbes start to produce toxins – haemo lysines, leucocidinum, neurotoxin in the wound. Enzymes (plasma coagulase, hyaluronidase) play an important role in the development of an infection. The macro organism also enters into this battle his forces and even reserves, and this battle is won only by whom who possesses bigger resilience, large supplies of protective forces. What are reciprocal shifts in the macro organism? They are divided into local and general. Local changes are typical for inflammatory reaction – arterial hyperemia, venous stasis, temperature increase, function violations, pain, exudation, migration of neutrophil, leukocytes.
General reaction develops along with local reaction; the intensity of this reaction depends on the number of bacterial toxins and products of disintegration of fabrics which have got into the organism from the center of affection, and on resistibility of the organism.
Clinically general reaction is expressed by temperature increase, fever, excitement or slackness of the patient, blackout or loss of consciousness, headache, indisposition, weakness, pulse increase, changes in hemogram (leukocytosis up to 25-30 thousand), morphological, functional and biochemical changes, decrease of blood pressure, stagnation in a small circle, high erythrocyte sedimentation rate.
Prevention of a surgical infection is formed of a number of conditions, mainly of the level of the sanitary-and-hygienic condition of the population, prevention, and treatment of micro traumas in production and in life, in the organization of ambulance and emergent surgical assistance to the population at traumas and diseases.
Prevention of suppurations of operational wounds is provided with strict observance of all rules of asepsis, gentle and sparing operating.
The basic principles of treatment of a sharp purulent infection are divided into conservative methods, surgical treatment, and antibiotic therapy. Complex application of antibiotics, conservative and operative actions give the best effect.
Conservative methods of treatment should reduce purulent intoxication, suppress active involvement of micro florae, increase protective possibilities of the organism, and accelerate its regenerative ability. These methods are divided into local and general treatment.
Local treatment provides rest, an immobilization of the struck extremity, pus evacuation, drainage, use of liquid antiseptics and antibiotics, operative intervention, physiotherapy, application of heat, cold etc.
These actions should promote stopping and decrease of pain in the inflammation zone, restriction.
For purposeful use of thermal physiotherapeutic procedures it is necessary to know localization and the phase of the development of the inflammatory process.
Thermal, heating and physiotherapeutic procedures are used with success and kill pains before the formation of the pus, but these actions strengthen and extend inflammatory changes at the formation of the pus, strengthen tension of fabrics, promote break of barriers and the abscess. The cold calms hypostasis of fabrics in the first phase of process limits pains and even liquidates them, however at long application it causes ischemic necroses, reduces local resistibility of fabrics in connection with blood circulation violation. Antiseptics, antibiotics in solutions and in dry form, proteolytic enzymes of animal and microbic origin are used in local treatment.
The major factor in the treatment of a purulent surgical infection is an operation, however, quite often it is forgotten about it and it resorts too late.
The indication of operation is established after unsuccessful conservative treatment and in all cases of formation of the pus which threatens with breaking into a cavity, or general purulent infection (sepsis) which can lead the patient to death.
However, local treatment not always leads to desirable success, especially at the prevalence of the process at general exhaustion, decrease in reserve possibilities, the reactance of the organism etc.
General treatment provides fight against purulent intoxication, an increase of protective forces of the organism, suppression of the activity of micro flora, normalization of functions of cardiovascular, nervous, hemopoietic systems, liver, kidneys etc., metabolism, improvement of the possibility of regeneration of fabrics. For the purpose of the dis-intoxication physical solution, a solution of glucose, blood, hydrolyzates, albuminous etc., high-calorific food, vitamins, repeated blood transfusion, plasma transfusion is applied – all this increases protective forces of the organism. Antibiotics provide benefit at their correct purposeful use, if character and resistance of micro flora, the sensitivity of the patient to these preparations etc. have been defined previously. Quite often we resort to the means which improve the condition of the cardiovascular system (glucose, corglicon, cordiamin, strofantin), of the nervous system (at excitement – hypnotic drugs, bromides, anesthetics). Sollux, quartz, UHF, the ointment bandages, sparing relation to granulated fabrics etc., biostimulation, transplantation of fabrics are applied at some patients for activation and acceleration of the process, reparation, regeneration of fabrics at creating conditions for this purpose etc.