Surgical-site wounds can become infected with a variety of bacteria. The most common organisms include: S. aureus, S. epidermidis, and gram-negative enteric bacteria, such as Serratia marcescens and anaerobes.These infections can cause many complications and contribute to increased morbidity, length of hospital stay and cost.
Wound Dehisence
Patients who ungergo heart transplantation have an incision through the middle of their breast bone, a median sternotomy to provide access to the heart. After surgery, circular wires hold the front of the chest together, while sutures close the wound in the overlying skin. According to "Harrison's Principles of Internal Medicine," sternal wound infection and infection of the middle of the chest, or mediastinitis, represent early postoperative complications. The infection can spread to the bones in the sternum, which can loosen the wires, and the wound can open, or undergo dehisence. This very serious infection requires drainage or removal of infected tissues, intravenous antibiotics and rewiring of the chest bones to repair.
Gangrene
The heel has thin skin and a bony prominence. Pressure sores, or decubitus ulcers, on a heel can develop in an elderly patient who has undergone a partial hip replacement, if preventative measures are not taken, including: turning the patient frequently while in bed, use of heel protectors or putting a pillow under the knee joint. This trivial break in the skin can become infected with bacteria that invade the skin, or cellulitis. From there, the infection can progress to involvement of the heel bone, or osteomyelitis. If not treated with aggressive wound care, surgical removal of dead skin, or debridement, the infection can involve the vessels in the leg, causing the catastrophic infection gangrene, which requires amputation of the leg.
Bacteremia
One of the biggest dangers of deep pressure sores occurs when bacteria enter the bloodstream, or bacteremia, defined as the presence of bacteria in blood cultures, according to "Harrison's Principles of Internal Medicine." Sepsis, a rapidly progressing, life-threatening condition can cause shock and organ failure, according to MayoClinic.com.
References
- "Harrison's Principles of Internal Medicine;" Dennis Kasper, M.D.; 2005
- Mayo Clinic: Bedsores (Pressure Sores) Complications
