Management

Management of Infected Wound

December 29, 2023
SR Publications

D. S. Gonge1, Amit shakya2, Jitendra yadav1, Vyankat j. Jadhav3

It is defined as disruption or discontinuity in the skin, tissue or mucous membrane caused by physical, chemical or biological agent.

Wounds are surgical entity and require thorough attention. The treatment of the simple wound responds well however in septic wounds, it is problematic or complicatory. If the treatment is not started in time it may terminate to septicemia or toxemia resulting to the fatal consequence or serious complication. The simple or suspicious wound may convert to septic wound therefore proper attention is needed well in time for the treatment of septic wound.

A. Classification

  • Open wound
  • Closed wound

B. Clinical classification

(i)         Clean – (Class 1) Clean lacerated wound of 0 to 6 hr duration with minimal contamination.

  • Contaminated (Class 2) 6 to 12 hrs duration with significant contamination.
  • Dirty (Class 3) 12 hrs. or longer duration with gross contamination.

Septic wound

Also called infected / suppurative / contaminated / dirty. “An infected wound is one in which micro-organism have invaded the tissues and have started multiplying and producing toxins”.

            “A fresh wound get contaminated when it is more than 4 or 5 hrs. old”.

2. ETIOLOGY

Any wound may convert into septic wound with invasion of pathogenic microorganism.

3. SYMPTOM OF WOUNDS

Local symptoms

  • Haemorrhage.
  • Pain.
  • Gaping of the lips of the wound.

Systemic symptoms

  • Febrile disturbance.
  • Signs of toxemia. 
  • Swelling or abscess formation may occur in dependent lymph gland.
  • Neuritis extending along the course of a nerve involved in the wound.

4. DIAGNOSIS

History provided by the owner regarding the wound is of importance; as it will provide      information in regard to manage mental aspect of the wound. The sources of wound   contamination eg stool, urine and barbed wire should also be kept in mind. The  secondary bacterial infection by microorganisms especially in case of horses as Clostridium tetani causing tetanus must be kept under consideration, as further complication will take place and wound healing will be delayed. eg:- Dog bite, Accidental.

A.        Visual examination: – Presence ofdust, dirt, pus and foreign bodies.

B.        Clinical examination – Recording of the temperature, pulse rate, respiration rate, and appetite.

  • Nature of exudates:-Color, odour. 
  • Nature of pus :-
  • Thin watery pus with offensive odour than the infection can be suspected for Bacillus coli.
  • Greenish color pus than the infection can be suspected for B.pyocyaneus.
  • Abscess formed, production of frank pus, thick & creamy color than the infection can be suspected for Staphylococcus.
  • No abscess formation, watery, thin & scanty discharge than the infection by can be suspected for Streptococcus.
  • Lesion on the muscle tissue – ischemia, necrosis & gangrene.
  • Surface & Margin of wound (raised or depressed) – Surface is variegated with grayish & blackish spot if wound is recent.
  • Depth of wound or its link with fistulous tract, if any, as in case of maggoted wound.
  • Biopsy: Bacterial culture and antibiotics sensitivity test.

5.         GENERAL MANAGEMENT OF SEPTIC WOUND

  • Cleaning of wound

The hair around the wound are clipped, taking  care to see that cut pieces of hair do not enter the wound. The wound and surrounding areas are irrigated with mild, non-irritant antiseptic eg: solution removing dead tissue.

eg:-      Solution is used perchloride of Hg (1 in 1000) acriflavin solution  (1 in 500).

            Wound is washed with warm normal saline and soap or 2% H2O2. 5% Dettol or Savlon.

  • Debridement and trimming of wound
  • Most important mode of wound therapy to prevent dead and damage tissue which serves as a bacterial media.
  • Scalpel should be used to remove shredded muscle, torn fascia, black discoloration of skin.
  • Dead debris is removed by probe.
  • Artery, vein, nerve, tendon and ligament should not be injured.

Medicament: – 2.5% sod. Chloride solution, povidone iodine.

  • Control of infection

After irrigating the wound it is covered with a moist antiseptic pad or an antiseptic powder or ointment.

eg:- Antiseptic powder as boric acid Sulphanilamide, Iodoform.    

Ointment – Streptomycin, terramycin.

  • Closure of wound

Wound with extensive destruction like in gunshot motion, bite case of extensive spoilage by intestinal content or external source if clinician is not still convince about treatment then removal of contamination for few day.

  • Drainage of wound
  • A drainage should be provided to evaluate pus, exudate serum etc.
  • In case of deep wound fenestrated rubber tube is kept in the wound to provide dramage. The drain is generally removed after 4-5 days or after cerration of exudate.
  • Dressing of the wound
  • Depending upon the nature the wound should be dressed with antiseptic / antibiotics ointment or chemical debridiment agent. 
  • Dressing done by covering with gauze and bandage over the wound.
  • Dressing should be daily for 5-7 days.
  • Provide counter opening to facilitate drainage of pus.

(h)       Suture material used in septic wound

  • If suturing is unavoidable and there are chances of produce suture sinus formation then preference for synthetic absorbable sutures material should be given eg. Catgut, Polyglactin (vicryl), Poly glycolic acid (Relyon).
  • The occurrence of sinus is greater with non absorbable material than catgut.
  • Braided non absorable suture material others than steel should not be used because there are risk of sinus air abscess formation.

6.         SPECIFIC MANAGEMENT OF WOUND

  • In case of horse: A prophylactic dose of antitetanus serum (1500 to 3000 unit) is always recommended because of their great susceptibility to tetanus and also antitetanus  globulin is used.
  • In case of maggot infestation : The wound should be initially dressed or irrigated with phenyl solution or a combination of oil to kill the maggots and use of Ivermectin, Turpentine, Lorexane, Topicure, Skin heal, D-mag.
  • In case of dog bite: These wound are deep, caused by penetration by teeth of dog. They are of special concern because various pathogenic organisms found in the mouth of animal are carried deep into the wound; there is chance of contracting rabies if bitten by an infected dog. The wound should be washed with plenty of soap and water and use antirabies vaccine.   

7.         SUPPORTIVE THERAPY

  1. Fluid therapy: – Dextrose and saline injection, normal saline solution containing 5-10% glucose may be used to treat shock and haemorrhage.
  • Injection of antitoxic serum.
  • Provide good hygiene and management.
  • Blood transfusion.
  • Thermotherapy.
  • Vit-C – is necessary for the formation of intercellular substance and maturation of pre-collagen of connective tissue. Vit-K is concerned with coagulation of blood.