IMPORTANT

SURGICAL
INFECTIONS
BCQS
1.ALPHA LECITHANASE IS
VIRULENT FACTOR
A. Clostideum Tetani
B. Vibrocholorea
C. Clostidia Difficle
D. Clostidia sprogenicom
E. Staphlococci
2. SPORE IS VIRULENT FACTOR
OF
A. H Inflenza
B. Gonococci
C. C Bottluinum
D. C Tetani
E. Meningococcus
3. 25 YEAR OLD MAN PRESENTS WITH
SMALL ABSCESS TWO DAYS DURATION...
THIS IS A STEREO TYPICAL HISTORY OF
FOLLOWING DISEASE
A. Catalase +ve Cocci
B. Catalase –ve Cocci
C. Gram –ve Cocci
D. Gram +ve rod
E. Gram –ve rod
4. 25 YEAR OLD MAN WITH
COMPOUND FRACTURE OF TIBIA
PRESENTS WITH TOXIC SYMPTOMS
BLACK SKIN & BLEBS… CAUSES?
A. Staphlococcus Osteomalytis
B. C Sporogenicum
C. Gonococcus
D. Nocardia
E. Lyme disease
5. LADY PRESENTS WITH RED PAINFUL
ARYTHEMATOUS RASH… CAUSES?

A. Staphlococcal infection
B. Steptococcal infection
C. Coxciella B Virus
D. C diffcile
E. Gram –ve organism
6. CLAMADIYA INFECTION IS IMPORTANT
TO SURGEON BECAUSE OF …
A. Metastatic Abscesses
B. Brain Abscesses
C. Lung Abscesses
D. Reiters Syndrome
E. Conjuctivitus
7. URINE LEUCOCYTE ESTRESE
TEST +VE MEANS?
A. Viral Infections of Urine
B. Gram –ve Infection of Urine
C. Bacterial Infection of Urine
D. Chalmadial Infection of Urine
E. Malaria
8. SPREADING CELLULITIS
(BEST ANSWER IS )?
A. More Common in homosexual persons
B. Diabetics
C. Old Age
D. Patient on immuno compromise drugs.
E. Patient having infection steptococcus
9. TETANUS SPASM IS BECAUSE
OF ….?
A. Blocking of ACH
B. Blocking of Glycine & Gaba
C. Blocking of H 2 Receptors
D. Blocking of Alpha 1 Receptors
E. Blocking of Alpha 2 Receptors
10. MELENEY’S GANGRENE IS…?
A. Synergestic organisms
B. Stephlo, Strepto and other organisms
C. Is localized gangrene of the tissue.
D. More common in old peoples
E. More common in the back
WOUND CLASSIFICATION
AND ITS MANAGEMENT

Presented by:
Dr. Nazimuddin Jat
FRCS
OUTLINE
 Definition
 Classification
 Open wound
 Closed wound/Internal wound
 Symptoms
 Management of Wound
 Cleaning of wound/ irrigation of wound
 Wound debridement
 Control of infection
 Providing drainage
 Immobilization of wounded area
DEFINITION
 A wound is a break in the continuity of soft
tissues
 A wound is defined as a separation or
discontinuity of the skin, mucous membrane
or tissue caused by physical, chemical or
biological insult
CLASSIFICATION
1. Open wound
2. Closed Wound
Open wound
3. Incised wound
4. Lacerated wound
5. Penetrated wound
6. Perforating wound
7. Puncture wound
8. Gunshot wound
9. Abrasion wound
10. Bite wound
11. Virulent wound
 Ulcerating wound (VVS Ulcer)
 Granulating wound (Healing Wound)
 Septic wound (Infected wound)
 Aseptic wound (Surgical)
CLASSIFICATION
CLOSED WOUND

1. Contusion or Bruises
2. Haematoma
 Open wound

There is discontinuity in the skin and

other covering tissues to a varying
depth
CLASSIFICATION
 Incised wound
 Caused by sharp cutting instruments.
 Minimum loss to tissue tends to gap (the extent
of gaping depends upon elasticity and tension).
 Edges are regular.
 Bleeds freely and painful.
 Heals by primary intension healing.
 Lacerated wound
 Caused by tearing of tissues,
 Wounds have irregular jagged borders
 Loss of tissue is limited to skin and s/c tissue.
 eg: barbed wire.

 Penetrated wound
 Cause by sharp pointed objects like nails
 Have relatively small opening.
 May be very deep.
 Infection/ foreign particles might have been
carried deep in to wound
 opening is inadequate for drainage.
 eg: punctured wound on foot due to gathered
nail.
 Perforating wound
 Have two opening one of entrance and other of exit.

 Punctured wound
 Deep wounds communicating with cavities like
adbominal, throrax,joints etc.
 eg: stab wounds

 Gunshot wound

 Abrasions wound
 Bite wound

 Virulent wound
 Caused by bacteria or virus. leading to formation
of pustules or vesicles.
 Eg: anthrax, TB organisms

 Ulcerating wound
 Granulating wound
 Septic wound
 Aseptic wound
ULCERATING WOUND
GRANULATING WOUND
CLOSED WOUND/ INTERNAL WOUND
 In closed or internal wound only deeper
tissues, barring the skin or mucous
membrane are damaged.
CLASSIFICATION
1. Contusion or Bruises
 Produced by blunt objects

 Results in damage to subcutaneous tissue without

breaking the continuity of the skin surface.

 Classified into 1st, 2nd and 3rd damages according to

the extent or severity of the injury.
 Bruise harm score
Harm score Severity level Notes
0 Light bruise No damage
Less than
1 Little damage
Moderate bruise
2 Moderate bruise Some damage
3 Serious bruise Dangerous
Extremely serious
4 Dangerous
bruise
5 Critical bruise Risk of death
 Mild degree of contusion characterized by rapture of
capillaries in skin giving rise to a reddish blue or
purplish condition of the skin (Echymosis).

 First degree: There is rupture of capillaries of the

skin and subcutaneous tissue to form echymosis.

 Second degree: Larger vessels are ruptured leading

to the formation of haemetoma.

 Third degree: Tissues are considerly damaged and

gangrene may set in. the internal organs which may
also be impaired and there might be evidence of
impending shock.
2. Haematoma:
 Collection of blood beneath the skin
 Caused by injury to a superficial vein.
 Frequently seen s/c or submucosally.
SYMPTOMS
 Local

 General

Symptoms Depends
Upon size/Place/
Sterility
LOCAL SYMPTOMS
 Hemorrhage
 Pain
 Gaping of the edges of wound
 Phenomena of repair
 Abscess formation in a draining lymph nodes
 Paralysis or a loss of function in a dependent
portion
 Neuritis extending along the course of the nerve
involved in the wound.
GENERAL SYMPTOMS
 Febrile disturbances
MANAGEMENT OF WOUNDS
 Contusions: are treated with cold and
astringent applications to minimize
extravasation.

 Haematomas: when small get absorbed ,other

wise they may have to be opened and treated.

 Open wound: surgical or aseptic wound/

contaminated and septic wound/ accidental
traumatic wounds.
SURGICAL OR ASEPTIC
WOUNDS
 A surgical wound made with all aseptic
precautions in a non infected tissue is an aseptic
wound.
 Surgeon should avoid drying of the tissue,
excessive trauma and haemorrhage – lower the
wound infection.
 Prophylaxis against tetanus
 Drainage should be provided if haemotoma or
seroma formation is expected.
 Suture should be supported up to healing time 8
-14 days
 Systemic use of specific antibiotics as a
therapeutic or prophylactic measure.
 The patient and the affected injured part should
be kept at rest
CONTAMINATED AND SEPTIC
WOUNDS
 A fresh wound gets contaminated when it is more than
4 -5 hours old.
 Management is mainly directed towards overcoming
factors like.
 Type and number of invading micro organisms
 Type and location of the wound
 Poor blood flow at the wound site
 Effective ness of the treatment
 Presence of foreign material
 Dead tissue at the wound site.
GENERAL PRINCIPLE
 Control of haemorrhage: Bleeding is controlled
and ligating large vessels if any

 Clipping and shaving of large area around wound

CLEANING OF WOUND/ IRRIGATION
OF WOUND
 The wound and surrounding areas are irrigated with
mild, non irritant, antiseptic lotions:
1:1000 Per chloride of mercury lotion.
1:500 acriflavin lotion
1:40 Eusol lotion (Eupad is 1:40 bleaching
powder + boric acid)
5 – 10 % hyper tonic salines.
 If wound is fresh suturing may be attempted
 Infected and deep penetrating wounds are not
sutured
 Wounds that are not sutured should be irrigated daily
or on alternate days
 Wounds of feet: warm antisepic foot baths may be
given with 10% formalin
WOUND DEBRIDEMENT
 Debridement for removal of devitalized or
necrosed tissue is either done by excising the
unhealthy tissue or by use of topical
mendicaments

 2.5% sodium chloride solution.

 Magnesium sulphate and glycerin paste.

CONTROL OF INFECTION
 After irrigation and debridement wound may
cover with
 Moist antiseptic pad / antiseptic powder /
ointment.
 Antiseptic powders, boric acid,
 Ointments: Boric ointment, penicillin ointment,
streptomycin, chloromycin ointment, terramycin
ointment.
 Application of very strong antiseptics should be
avoided as it will destroy granulation tissue.
PROVIDING DRAINAGE
 If there is exudation and discharge the wound
should not be sutured.

 Deep wounds – fenestrated tube is advisable for

drainage

 Deep wounds with narrow external opening – may

be enlarged for efficient drainage.

 Counter opening may be made in a dependent

part seton may be passed through it.
IMMOBILIZATION OF WOUNDED AREA
 If proper immobilization is not provided healing
is delayed, formation of excessive granulation
tissue (Exuberant granulation / proud flesh)

 Application of caustics – copper sulphate,

potassium permanganate
ACCIDENTAL TRAUMATIC
WOUNDS
 Check hemorrhage
 Avoid development of shock
 Prophylaxis against tetanus
 Cleaning, excision, debridement
 Systemic antibiotic treatment