TETANUS

2. ANAEROBIC INFECTIONS

The anaerobic infections are of importance for they are the
dreaded complication that occur in surgical practice whenever the
system of asepsis and sterilisation of a hospital breaks down.

* These infections can also occur as a result of TRAUMA in
domestic, traffic, industrial accidents and DISASTERS
(earthquakes, train and air accidents etc.)
* WAR injuries also lead to an increased incidence of
anaerobic infections.
* They can occur in clean contaminated surgical wounds when
the GI tract is ENTERED in a surgical procedure.

2.1 Tetanus
Tetanus is caused by Clostrodium Tetani

- A gram positive bacillus, which forms spores and appears as a drumstick under the microscope.
- It is highly resistant to physical agents, and cannot be
destroyed by drying or heat.
- Soil in the street is contaminated with animal excreta
containing this organism.
- In hospitals, infection may be traced to inadequately treated
catgut, or inadequately sterilized instruments, linen and
supplies.
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INFECTION HAND-PARONYCHIA

1.5.5 Thenar Space:
The infection is confined to the thenar part of the palm the
thumb is abducted.

Treatment:
Incision in the web between thumb and index finger carved
incision on the dorsal aspect or curved incision in thenar crease
on the palmer surface.
Insert an artery forceps open absces and connected cavities clean drain and dress.
Sling is required to reduce pain
Antibiotics and analgesics may also be required.

1.5.6. Paronychia:
This is an infection around the nail or under the nail. The
infection is superficial, the swelling, redness and a bead of pus
often can be seen.

If the infection shows pus a direct incision is required to drain
the pus on one or both sides of the nail.
Sometimes raising the cuticle from the nail will drain the pus.
If the infection does not settle, fungus infection should be suspected and scraping examined and anti-fungal local ointments applied.
Pulp space and apical infection are also treated by incision
dressage.
All require dressing slings and analgesics.

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HAND INFECTIONS

HAND INFECTIONS 2

1.5.3 Superficial palmer space
With the infection of this space,pus lies superficial to the tendons in the palm, and under the palmer fascia, a collar and stud abcess may show pus in the palm, infection occurs through abrasions on the palm while working.
Appearance:
The hand is swollen on the palmer aspect, the finger flexed with maximum tenderness in the palm, with a possible visible pus point.
Treatment:
Place a transverse incision in palm, on the point of maximum tenderness. The incision is placed in the skin crease, probe the abcess cavity open all areas.
Pack and dress the wound and keep arm in a sling. Antibiotics and analgesics may be required.

1.5.4 Mid palmer space
The pus is deep to the flexor tendons; the space lies superficial to the interossei and metacarpals.
It is separated from the thenar space by fibrous septa from the middle finger metacarpal to the palmer fascia.
Signs:
The hand is huge and swollen almost like an inflated glove. The middle and ring fingers cannot come close and cannot hold a paper sheet.
Treatment:
Use GA and a tournquet
A transverse incision is required in the skin crease, enter the space by the side of the flexor tendons of the ring finger using blunt dissection after incision of skin, do not injure nerves and tendons. Clean, drain, and dress the wound.
Prescribe antibiotics, analgesics, and sling or suspend hand vertically.
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INFECTIONS IN SURGICAL PRACTICE

1.5 Hand Infections

1.5.1. Anatomy The hand is a special part of the body and is used for holding and lifting objects. It is also used for fine controlled movements, like writing, painting and playing musical instruments. It is made up of bones, and joints, with muscle, and tendons to achieve these movements. The use of hands provides chance of injury, and break in skin cover leading to infections. There are spaces in the hand and fingers where this infection can spread to, and present to the surgeon for treatment.

1.5.2. Hand Spaces

1.5.2.1 Web spaces these are space filled with fat, three in number. They lie between the index, middle, ring, and little finger, and provide entry to infection. If not recognized early and treated, spread may occur to the mid palmer space.

Appearance Pain, and swelling of the dorsum of the hand are the presenting features. The fingers on either side of affected web space are separated. Maximum tenderness is on the palmer aspect.

Treatment: Incision, curve shaped in the web between the affected fingers. Probe and open all pus pockets, pack and dress, keep arm raised in a sling.

Antibiotic if infection is spreading, analgesics will be also required.

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