More often the suppuration of a wound occurs on the 5th-8th day after the operation.
The following are clinical signs of wound suppuration.
- Occurrence of local signs of infection:
- the presence of pain in the wound area, which usually have an increasing character (initially constant pressing, then "pulling" or pulsating) and decrease only after treatment or drainage of the wound or in case of spontaneous appearance of a wound detachable;
- the appearance of hyperemia and edema in the area of the wound (suture);
- divergence of the edges of the wound, appearance of serous or purulent discharge;
- local hyperthermia.
- The emergence of a general reaction:
- deterioration of the general condition (weakness, lack of appetite, sleep disturbance);
- increase in temperature - wound infection is characterized by a hectic fever - hyperthermia (above 38 ° in the evening with a decrease in temperature to normal and subfebrile in the morning;
- the appearance of chills;
- the appearance of symptoms of intoxication - tachycardia, sensation of dry mouth, "brokenness", muscle pain;
- inflammatory changes in the blood (an increase in ESR, an increase in the number of leukocytes, a shift of the leukocyte formula to the left, lymphopenia).
As a rule, the general reaction of the body (purulent-resorptive fever) with wound infection always corresponds to the size of the changes and the nature of the process.
In case of inconsistency of local changes to the general state, one should assume:
- presence of other purulent foci (abscessing in the small pelvis and abdominal cavity, pneumonia, etc.), which need to be identified, since there is often a combination of wound infection and infection of the surgical site;
- the presence of a particularly virulent pathogen of wound infection (anaerobes, Pseudomonas aeruginosa), for the establishment of which additional bacteriological studies should be applied;
- generalization of infection, i.e. Sepsis.
As a rule, staphylococcal infection is accompanied by vivid clinical manifestations of the wound process, streptococcal - flaccid, for Pseudomonas aeruginosa is characterized by severe intoxication, for anaerobic (putrefactive) flora - rapid spread of the process to surrounding tissues, absence of demarcation signs with meager local manifestations.
In the case of inverse inconsistency (a mild general reaction in patients with extensive wound infection), one should keep in mind the possibility of hypo- and arecative reactions in patients with immunosuppression.
Changes in the immunorefection of the body and the use of massive antibacterial therapy can lead to atypical manifestations of wound infection, when local and general changes are expressed only slightly in a vast purulent process. These conditions are no less dangerous, since the disruption of adaptation mechanisms and the generalization of infection are possible.
Diagnosis is based primarily on the clinical signs of wound infection, which allows not only to assess the nature and severity of the wound process (when performing wound revision), but also to assume the type of pathogen.
To the wound infection also include festering hematomas of the anterior abdominal wall and perineum.
Causes - a violation of the technique of operations (hemostasis defects) or interference in the background of DIC syndrome in severe patients. The most extensive and subaponherotic hematomas are most severe and late. They are more common after abdominal pfannenshtil, when the aponeurosis is separated from the muscles in a large area, less often - in the lower intradosternal jelly. In the presence of hematomas, patients almost immediately after the operation are concerned with pressing or bursting pains in the seam area, which, in the beginning, are usually taken as the usual postoperative pain, stopping when prescribing narcotic drugs.
The detection of anemia of the middle and sometimes severe degree is also often regarded as intraoperative blood loss.
Only the suppuration of the hematoma and the attachment of signs of infection make it possible to correctly diagnose.