Treatment of surgical infection

Conservative therapy

In the initial stages of inflammation (before an abscess forms), the goal of treatment is to suppress the microflora and achieve resorption or delimitation of the process.

Main methods:

• Medical therapy: antibiotics, antiseptics, anti-inflammatory drugs, and enzymotherapy to relieve edema.
• Physiotherapy: compresses, UV therapy, UHF therapy, laser therapy.
• Regimen: absolute rest for the affected organ is mandatory (immobilization, bed rest).

During the infiltration phase, procaine blockades and infusion detoxification are additionally used. In the purulent phase, conservative methods (puncture, pus aspiration, antiseptic irrigation) are permissible only to a limited extent, for example, when an abscess forms in natural cavities (arthritis, pleuritis).

Surgical treatment

The transition of inflammation into the purulent phase or the ineffectiveness of conservative therapy are direct indications for surgery. Warning symptoms include increasing intoxication, fever, tissue breakdown, and the development of lymphangitis.

The essence of surgical intervention is the removal of the focus and detoxification:

1. Approach: the incision should be short, but wide enough for pus evacuation. It is placed at the lowest point for gravity drainage.
2. Debridement: removal of necrotic tissue (necrectomy) using a scalpel, laser, ultrasound, or proteolytic enzymes. The cavity is washed with antiseptics.
3. Drainage: the final stage of any such operation. Active suction and counter-incisions (additional cuts) are often used for better outflow.

Antibiotic Therapy

Antibiotics are prescribed only when necessary, taking into account medical history and contraindications (e.g., pregnancy, kidney disease).

• Before identifying the pathogen, broad-spectrum drugs are used (empirical therapy).
• Once the antibiogram is obtained, treatment is switched to targeted therapy.
• In polymicrobial infections, combinations of drugs with different spectra are used to achieve a synergistic effect. It is important not to combine drugs of the same group (e.g., aminoglycosides with each other) to avoid compounding their toxicity.

Detoxification and body support

Severe infections require correction of homeostasis:

• Intracorporeal detoxification: infusion therapy for hemodilution, forced diuresis (fluid load + diuretics + replacement) with preserved renal function, enterosorption.
• Extracorporeal: plasmapheresis (removal of plasma with toxins) and hemoperfusion (passing blood through charcoal filters).
• Blood transfusions and immunomodulation: transfusion of red blood cell or leukocyte mass, plasma, albumin, and administration of specific γ-globulins to maintain blood volume and immunity.

Class and exam questions

What else to study on this topic

• Mechanism of action of proteolytic enzymes in the inflammatory focus
• Features of the use of quinoxaline and nitrofuran derivatives
• Correction of protein metabolism in acute and chronic purulent processes
• Specific immune drugs (hyperimmune plasmas, sera)
• Hemodynamic parameters: blood volume, circulating blood protein, hematocrit and selection of transfusion medium

Other topics from the section "CHAPTER 11. SURGICAL INFECTION (PURULENT-INFLAMMATORY DISEASES)"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.