PDF(Pubmed)
Abstract：
Early recognition and treatment of surgical site infection (SSI) may prevent devastating consequences of wound infections complicating caesarean delivery (CD). SSI complicates 3-15% of CDs; among the severe forms are necrotising fasciitis (NF) and clostridial gas gangrene, with the latter being the most rapidly spreading and fatal. The aim of this report is to improve early recognition of SSI complicating CD. An obese 32-year-old woman, gravida 2 para 1, with a previous uncomplicated vaginal delivery had a CD for fetal compromise in a district hospital. On day 6 after delivery, she presented to the same district hospital with a small blister located on her abdomen above the CD wound. The area around the blister was firm but had no crepitus. The blister was managed expectantly but spread rapidly and had a dusky colour. Both the blister and the surgical site for CD subsequently became foul smelling and the patient was managed in a regional hospital, where she had antibiotic therapy, wound debridement, negative-pressure wound therapy, and secondary wound closure. Healing was complete 69 days after the debridement. The histological report of the wound biopsy confirmed NF. In conclusion, blistering around a surgical site is suggestive of NF. Healthcare professionals managing surgical wounds should have ongoing training on SSI to prevent lack of problem recognition in wound care. All healthcare facilities managing surgical wounds should establish a functional wound care clinic to improve early recognition and treatment of SSI. This entails effective integration of postnatal and CD wound services to improve the care of SSI. Therefore, the algorithm included in this article will be invaluable to care providers.
摘要：
手术部位感染（SSI）的早期识别和治疗可以防止剖腹产（CD）并发症的伤口感染的破坏性后果。SSI会使3-15％的CD复杂化；在严重形式中，坏死性筋膜炎（NF）和梭菌气坏疽，后者传播最快，也是致命的。本报告的目的是提高对SSI复杂CD的早期认识。一个肥胖的32岁女人,gravida2para1，先前无并发症的阴道分娩在地区医院有胎儿受损的CD。交货后第6天，她被送到同一地区医院，在CD伤口上方的腹部有一个小水泡。水泡周围的区域是坚固的，但没有毛骨悚然。水泡得到了预期的管理，但传播迅速，颜色暗淡。CD的水泡和手术部位随后都变得难闻，患者在地区医院接受治疗，在那里她接受了抗生素治疗，伤口清创术,负压伤口治疗,和二次伤口闭合。清创后69天完全愈合。伤口活检的组织学报告证实了NF。总之,手术部位周围起泡提示NF。管理手术伤口的医疗保健专业人员应接受持续的SSI培训，以防止伤口护理中缺乏问题识别。所有管理手术伤口的医疗机构应建立功能性伤口护理诊所，以改善对SSI的早期识别和治疗。这需要有效整合产后和CD伤口服务，以改善SSI的护理。因此,本文中包含的算法对护理提供者来说将是无价的。
