Wound Infection

CLINICAL FEATURES Wound infections may occur early post-operatively or up to several months after the surgery. Greater than 90 percent occur within the first 2 postoperative weeks. Early infections are characterized by fever, tachycardia, increased wound tenderness, and local cellulitis. As the infection progresses, the wound may be fluctuant or indurated. Wound breakdown and dehiscence can occur if treatment is not initiated rapidly. The infected incision is swollen, erythematous, edematous, and tender. There may be spontaneous purulent drainage from the wound. Initial management consists of opening the incision, probing with a sterile cotton swab to maintain fascia integrity, vigorous cleaning with a fifty-fifty mixture of hydrogen peroxide and saline solution, and packing with saline-soaked wet-to-dry dressings. If staples have been placed, they should be removed. Aerobic and anaerobic cultures could be obtained. The operating gynecologist should always be informed about the patient. Late-onset infections are characterized by persistent low-grade fevers and purulent drainage from the incision. Local wound care, as described above, is appropriate.

DISPOSITION Parenteral therapy with a penicillin-based antibiotic and aggressive local wound care are typically used for early postoperative infections, particularly when there is underlying cellulitis. Most patients are readmitted.

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