Infection and wound healing, infected wounds, ulcers, injuries, non healing wounds, wound management, scalp injury, road traffic accident, rta, head injury, tissue loss, wound scalp, exposed skull, fracture skull bones, plastic surgery, cosmetic surgery, Dr Alexander, Cochin, kerala, India+

When germs or microorganisms attack a wound and cause infection, they hamper the normal wound healing process. Some of them release toxin, damage the tissues, degrade growth factors, increase the collagen break down and also reduce the epithelisation: processes that are necessary to heal the wound. Even if the wound heals, in the presence of infection the chance of scar formation is higher. Further surgical procedure like skin grafting and flap that are carried out to heal the wound, which though may be technically perfect, fail in the presence of infection. The skin graft fails to stick to the wound bed, floats or is eaten up. The skin flap may show inflammation and even areas of necrosis (tissue death). Therefore it is imperative that one recognizes the presence of infection in the wound and treats it at the earliest. The picture below is of a complex scalp wound that needs to be carefully managed to heal the wound.

Antibiotics are often used to control infection but one has to understand difference between wound colonization and wound healing. In wound colonization the germs are just visitors and don’t really damage the tissue, though they do have a potential to cause infection (become illegal residents). We avoid antibiotics in these cases and use local antimicrobial agents and dressings to cleanse the wound. However in wound infection, the germs have now become illegal residents of the wound and seek to damage and destroy tissue and prevent wound healing. These wound show signs of infection like redness, swelling (cellulitis), and foul smelling discharge; lacks peripheral epithelisation, has poor granulation, looks unhealthy and shows poor healing. In such cases we can start appropriate antibiotics based on the germs (organisms) we culture from the wound. To confirm wound infection one must look at the concentration of organisms per gram of tissue (tissue culture) ; more than 10 to the power of 5 organisms is considered wound infection. We don’t do this commonly as clinical signs and symptoms are fairly accurate to know if the wound is infected.

Sometimes the infection in the wound persists inspite of the patient having taken antibiotics.

This often happens because:
1. Different germs or microorganisms are sensitive/ resistant to different antibiotics that are used to kill a specific germ. Therefore culturing the microorganism from the wound is very helpful and important.
2. Sometimes the wound may be infected with more than one germ, so that we may need a combination of antibiotics to treat the infection.
3. Also it is a good habit to repeat the wound cultures on weekly basis to know if new organisms are isolated or resistant micro bacteria are present so that we can attack these invaders.

In patients with major and multiple wounds and also in burn patients these issues are extremely important as the microbial pattern keeps changing due to a lot of dead tissue (burn eschar).