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Infection

I am always concerned about infection with every surgical procedure I perform.

Infection is a complication that may occur with any surgical procedure. When the skin is cut, either by injury or by surgery, it is possible that bacteria can get into the wound and lead to infection. The risk of infection in elective surgery is generally about 1-2%. I always give you preoperative antibiotics through the intravenous line (IV) right before the operation begins to minimize the chance of infection. You will receive an antibiotic that is effective in killing the most common bacteria causing surgical infections. However, post-operative infections can still occur.

The risk of infection is increased if you have some medical conditions, including diabeteskidney failure and blood vessel problems. People who smoke, or are taking immunosuppressive drugs like methotrexate and prednisone, you are also at an increased risk for infection.

This does not mean we will not do surgery if you have these conditions. But we do recognize there is a higher chance of having a problem.

What to Look For
If a postoperative infection occurs, you will have increasing pain that develops several days after surgery.

There may also be redness seen about the surgical wound. This may not be visible under the dressing or splint. An infection in a toe that is exposed may show visible redness. If you have a K-wire that infection is occurring around, there may be redness in the toe, and drainage of fluid about the K-wire.

If your pain seems to be increasing several days after surgery instead of improving, please contact my office.

Treatment
Infections are treated with antibiotics. Different bacterial organisms are killed by different antibiotics. There are some bacteria that usually cause most of the infections after surgery, and I will initially treat you with an antibiotic used against them.

I will send samples of the tissue, wound drainage, or pus to the laboratory to determine what the exact bacterial organism is causing your infection. It usually takes 2 – 5 days to get those culture results. Then, the antibiotic regimen can be adjusted to ensure you are getting the best therapy.

Some antibiotics we can give by mouth, oral antibiotics, while some require an intravenous (IV) administration, IV antibiotics. Depending on the type of infection, you may require treatment with antibiotics for 1 week up to 6 weeks. If you need to have IV antibiotics for an extended time, arrangements can be made for home IV treatment. Usually a nurse will come into your home and administer the medications through a special type of IV line called a PICC line (Peripherally Inserted Central Catheter).

Sometimes infections require further surgical treatment. Removal of metal implants (wires, screws and plates) may need to be removed to eradicate the infection. You may also need debridement – removal of infected bone or tissue that the antibiotics alone will not penetrate. With some infections it may be necessary for you to be hospitalized to have repeated debridement surgeries, each separated by a few days.

After debridement the skin is sometimes kept open, and allowed to slowly heal over time.  This may take a few days or even weeks.  During this time the wound is sometimes treated by placing a clean dressing over it, and then changing the dressing once or twice daily.  That may be done by the patient or family, or may be done by a nurse.

In some instances a device called a WoundVac is placed over the wound.  This is a type of sponge that fits directly over the wound and is attached to a vacuum device.  This is placed on continuous pressure 24 hours per day.  This therapy often greatly decreases the time for the wound to heal.

It is always best to identify problems early, and that is certainly important with infections. If you are concerned about a possible infection, please contact my office.




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