Wound, surgical

Common Sites of Invasion Staph aureus Staph epidermidis inhabit most people s skin and are likely to infect wounds, surgical sites and indwelling catheters (causing infective endocarditis). Strep pneumoniae is often the cause of community-acquired pneumonia and adult bacterial meningitis. "Strep throat" is an infection caused by Group A beta-hemolytic Streptococcus. If untreated, it may elicit an immunologic reaction in the heart, joints and other tissues, known as rheumatic fever. 

The method of debridement selected will depend on the individual characteristics of the wound. Surgical and autolytic regimes are underpinned by encouraging the body s own healing... 

Chronic infections in contrast tend to be focal infections, limited in size, that wax and wane for long durations and are only partially destructive to tissues. The strategies of a single-cell, mobile, free-floating bacterium versus those of a community of bacteria encased in a self-secreted protective matrix (biofilm) are radically different and may one type of infections "chronic." Biofilm is intrinsically resistant to host immunity, antibiotics, and biocides, different treatment strategies will be required. Chronic infections such as chronic wounds, surgical-site infections, and infected implants will yield only to repetitive evaluation and multiple simultaneous therapies that require much persistence from the physician. 

Surgical handrub is the treatment of hands before the surgery, without the use of water, and it is directed against the transient and the resident microbial flora of the skin, in order to prevent the transmission of microorganisms into the surgical wound. Surgical handwash includes the use of water and an antimicrobial product (prEN 12054, 2001, see also Table 3.). 

In deeper, obviously contaminated, older or complicated wounds, surgical debridement is appropriate. Each wound is laid open along its long axis. Wounds should be thoroughly debrided and washed out with excision of all non-viable tissue. Fasciotomy may be necessary on occasion. As a guide, the 4c s criteria may be used -remaining tissue must demonstrate ... 

Elaborate precautions must be taken to prevent the entrance of Pu iato the worker s body by ingestion, inhalation, or entry through the skin, because all common Pu isotopes except for Pu ate a-emitters. Pu is a P-emitter, but it decays to Am, which emits both (X- and y-rays. Acute intake of Pu, from ingestion or a wound, thus mandates prompt and aggressive medical intervention to remove as much Pu as possible before it deposits in the body. Subcutaneous deposition of plutonium from a puncture wound has been effectively controlled by prompt surgical excision followed by prolonged intravenous chelation therapy with diethylenetriaminepentaacetate (Ca " —DTPA) (171). 

Surgical sutures are sterile, flexible strands used to close wounds or to tie off tubular structures such as blood vessels. Made of natural or synthetic fiber and usually attached to a needle, they are available ia monofilament or multifilament forms. Sutures are classified by the United States Pharmacopeia (USP) (1) as either absorbable or nonabsorbable. The USP also categorizes sutures according to size (diameter) and Hsts certain performance requirements. Sutures are regulated by the Food and Dmg Administration (FDA) as medical devices under the Food, Dmg, and Cosmetics (FDC) Act of 1938, the Medical Device Act of 1976, and the Medical Device Reporting regulation of 1995. 

Despite the universal use of sutures for wound closure, there is a need to utilize adhesives instead, because of their ease of use and the reduced risk of infection. Alkyl cyanoacrylate adhesives have been studied extensively for this use, and a significant amount of research has been performed to evaluate their interaction with living tissue [40,41 J. They have been approved for external use only, because of concerns with the fact that the polymers do not readily biodegrade and can cause inflammation around the area to which it was applied. However, these concerns are reduced for -butyl cyanoacrylate, as compared to the ethyl cyanoacrylate. There is even some evidence that their use as liquid sutures actually reduces the rate of infection around the healing wound or surgical incision [42J. 

At present there is only one commercially available tissue adhesive with approved on-label indications for skin closure. 2-Octyl-cyanoacrylate (Dermabond, Ethicon, Inc., Somerville, NJ) is presently indicated for skin closure in wounds which are not under extreme tension. This tissue adhesive is approved for topical skin application only. It is not indicated for internal use. The material is useful in closing traumatic skin lacerations [4,5] after wounds have been thoroughly cleaned as well as for minimally invasive surgical incisions and even larger surgical incisions in elective cases. The cyanoacrylate is applied while the skin... 

Spotnitz, W.D., Falstrom, J.K. and Rodeheaver, G.T., The role of sutures and fibrin sealant in wound healing. In Barbul, A. (Ed.), Surgical Clinics of North America — Wound Healing. W.B. Saunders, London, 1997, pp. 1-19. 

When an implant is surgically inserted into the human body, the internal environment is greatly disturbed. Haematomas are likely to collect around the implant, resulting in a lowered pH. Laing observed pH values as low as 4-0 in healing wounds. The low pH usually persists until the haematomas are reabsorbed after several weeks ... 

Panthenol is frequently used in ointments and solutions for the treatment of burns, anal fissures, and inflammation of the conjunctiva. The vitamin has to be substituted in patients on total parenteral nutrition and in those who regularly undergo dialysis. Hypervitamin-osis has not been observed for doses up to 5 g/d (22). Furthermore, the administration of pantothenic acid leads to improved surgical wound healing due to its antiinflammatory properties. 

Ms. Barker had a bowel resection 4 days ago. After a culture and sensitivity test of her draining surgical wound, the primary health care provider orders penicillin G aqueous IV as a continuous drip. Determine what questions you would ask Ms. Barker before the penicillin is added to the IV solution. 

Bleeding is the most common adverse reaction seen with the use of these drugp. Bleeding may be internal and involve areas such as die GI tract, genitourinary tract, and die brain. Bleeding may also be external (superficial) and may be seen at areas of broken skin, such as venipuncture sites and recent surgical wounds. Allergic reactions may also be seen. 

The reconstruction of the periodontal tissue with chitosan was a prelude to the discovery of the osteoinductive properties of chitosan [331]. Surgical wounds from wisdom tooth avulsions were treated with freeze-dried methylpyrrolidinone chitosan that promoted bone regeneration. Methyl-pyrrolidinone chitosan was useful in apicoectomy as well. None of the patients reported adverse effects over three years of observation [332]. 

Brekke, J. H., Bresner, M., and Reitman, M. J., Effect of surgical trauma and polylactate cubes and granules on the incidence of alveolar osteitis in mandibular third molar extraction wounds, Can. Dent. Assoc. J., 52, 315, 1986. 

The Center for Disease Control and Prevention conducted a randomized epidemiological study on patients who had received morphine nerve paste post-operatively for pain management purposes. Ninety-four percent of the patients used in the cohort presented themselves with surgical-site comphcations such as edema and inflammation 24 days (median) post-operation. Upon culturing of the wounds, 64% tested positive for bacterial infection. It is important to note that aU of the patients were found to have residual morphine paste on board indicative of a chronic morphine state (Sacerdote et al. 2000). 

Surgical hand disinfection. This term refers to the pre-operative disinfeetion of surgeons hands, with the aim of preventing surgieal wound infection. The most important criteria associated with surgical hand disinfection are ... 

The reduction of blood loss during or after surgical procedures where suturing or hgature is either impractical or impossible can often be accomphshed by the use of sterile, absorbable haemostats. These consist of a soft pad of sohd material packed around and over the wound which can be left in situ, being absorbed by body tissues over a period of time, usually up to 6 weeks. The principal mechanism of action of these is the ability to encourage platelet fiacture because of their fibrous or rough surfaces, and to act as a... 

Prior to 1977, trichloroethylene was used as a general and obstetrical anesthetic grain fumigant skin, wound, and surgical disinfectant pet food additive and extractant of spice oleoresins in food and of caffeine for the... 

These cements are the materials of choice for pulp capping (a wound dressing for covering an exposed or surgically treated pulp). They are superior to zinc oxide eugenol cements for this purpose (Mjor, 1963 Paterson, 1976). 

The nonpharmacologic treatment of diabetic foot ulcers may include off-loading, chemical or surgical debridement of necrotic tissue, wound dressings, hyperbaric oxygen, vascular or orthopedic surgery, and the use of human skin equivalents.30... 

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