Wound Infection

Wound infections can occur in all areas of gynecological surgery: as an infection of the skin incision after laparotomy, as infections of the trocar entry sites or infections of the vaginal stump, or after vaginal and vulvar procedures.

Risk factors. Apart from operative factors such as long operation duration, major intraoperative blood loss, or opening of the vagina, there are a number of other risk factors such as obesity, smoking, immunosuppressive drugs, pre-existing infection, or diabetes mellitus. Postoperative hematoma or seroma formation in the vicinity of the wound further increases the risk of a wound infection.

Prevention. The most important preventive measures for reducing wound complications in the skin and vagina are:

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  Preoperative antibiotic prophylaxis (cephalosporin)

  
  
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  Short operation time, with good assistance

  
  
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  Avoidance of major blood loss

  
  
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  Optimal hemostasis—avoidance of hematomas

  
  
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  Avoidance of excessive tissue trauma, e.g., excessive electrocoagulation

  
  
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  Closure of unphysiological spaces (“dead space”) by suture or drain, if necessary

  
  
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  Strict intraoperative asepsis: sterile operating field; adequate scrubbing-up of surgeon, assistant, and instrument nurse; compliance with rules regarding jewelry, short fingernails, gowning, face mask; adequate distance from onlookers

Clinical features. The symptoms of wound infection are pyrexia, more pain than normal in the wound area, and erythema and increased temperature of the wound area.

Treatment. Early wound infections can often be treated by adequate antibiotic cover. If an abscess develops or a hematoma becomes infected or spontaneous wound opening is immanent, operative measures are indicated. These usually comprise opening the wound, drainage of hematomas and abscesses, cleansing and excision of necrotic tissue. These procedures can be very unpleasant and painful, so they should be performed under anesthesia. After several days of open wound management, secondary wound closure is usually possible when the area is clean and infection has subsided. Allowing the wound to granulate should be reserved only for exceptional situations.

Necrotizing fasciitis. Necrotizing fasciitis is a rare, special form of wound infection. This is a severe and potentially fatal skin and soft tissue infection due to streptococci, rarely staphylococci, which leads to extensive necrosis and rapid deterioration in the patient′s general condition. The treatment consists mainly of resection of the entire affected area.