Emergency War Surgery NATO Handbook: Part II: Response of the Body to Wounding: Chapter XI: Infection
United States Department of Defense
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Reviewed
War wounds are characterized by lacerated, contused, and devitalized tissue; extravasated blood; disruption of the local blood supply; presence of foreign bodies; and contamination with various microorganisms, all of which predispose to the development of subsequent infection. The devitalized tissue and extravasated blood provide an excellent culture medium to support the growth of microorganisms and thus are conducive to the development of wound infections. Injury-related edema may produce tension within a fascial compartment that compromises the capillary circulation of the tissues within the compartment, resulting in local tissue anoxia. Additionally, the anaerobic character of hypoxic tissue may inhibit leukocyte phagocytosis or limit the function of leukocytes. The time lag between wounding and treatment represents an incubation period during which bacteria may proliferate and initiate infection. Early adequate surgery is therefore the most important step in prophylaxis against wound infection. A wound, debrided of nonviable contaminated tissue and left with an excellent blood supply, is best able to resist infection.
Although early antibiotic therapy plays an important role in the prevention and treatment of wound infections, antibiotics do not take the place of early surgical therapy. Antibiotic therapy should be based upon a knowledge of the likely causative organism and the antibiotic or antibiotics most suitable for controlling the organism.
Prophylaxis and early treatment are of the greatest importance. Once infection is established, it may be lethal and it is always costly in terms of further destruction of tissue, persistance of disturbed body physiology, delayed wound healing, and prolonged morbidity. Underlying medical problems, such as malignant disease, diabetes, malnutrition, and metabolic disease, may reduce an individual's resistance to microorganisms. These factors, however, are uncommon in the typical active duty military casualty.
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