General Surgery Rotation

General Surgery: Wound infections

Patient will present as → a 55-year-old white male with a history of degenerative arthritis of the knees underwent total knee replacement on the left knee without complication. The surgical incisions had closed without signs of surgical site infection. At the time, he made a good recovery. On a Friday morning, ten days after the right knee arthroscopy procedure, the patient noted swelling in the right knee with erythema. The patient also felt febrile with a general malaise. He went the Emergency Department that evening because of worsening symptoms and the onset of pain. His oral temperature was 101.8°F. The patient was tachycardic and had an elevated white blood cell count. With a working diagnosis of septic arthritis, the knee was aspirated. 

When do surgical site wound infections arise?
Classically, PODs #5 to #7

Wound infections usually appear between the fifth and tenth days after surgery

  • Presents classically with pain at the incision site, erythema, drainage, induration, warm skin, fever (usually the first sign)

Common bacteria found in postoperative wound infections:

  • Staphylococcus aureus (20%)
  • Escherichia coli (10%)
  • Enterococcus (10%)
  • Other causes: Staphylococcus epidermidis, Pseudomonas, anaerobes, other gram-negative organisms, Streptococcus, Clostridium (bronze-brown weeping tender wound)

CBC: leukocytosis or leukopenia (as an abscess may act as a WBC sink), blood cultures, imaging studies (e.g., CT scan to locate an abscess)

Remove skin sutures/staples, rule out fascial dehiscence, pack wound open, send wound culture, administer antibiotics

  • Traditionally, wounds that have been opened due to infection are left to heal by secondary intention

Adapted from surgical recall, by Lorne Blackbourne

General Surgery: Post-operative fever (Prev Lesson)
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