Pathophysiology of Post-Operative Surgical Wound Infection

Nursing
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Question 1
The underlying pathophysiology of a post-operative surgical wound infection. A wound that
is infected is a localized or excavation of the skin or the underlying soft tissue. Surgical site
infection requires contamination of the surgical site by microbes. The wound infection can occur
when the number of virulence microorganisms such as the bacteria and fungi overwhelms the
natural body defense mechanism (Weiss & Schaible 2015). This triggers the body’s immune
response which results in inflammation, tissue damage as well as a delay in wound healing. The
microorganisms causing infection can either originate from endogenous sources such as the
patient's skin or exogenous sources such as from contaminated items on the sterile surgical field,
team members and microbes from the air. These virulence microorganisms injure the viable
tissues surrounding the incision site. The damaged cells of the injured tissues release chemicals
likes of histamine, bradykinin, and prostaglandins (Widgerow & Kalaria, 2012). The released
chemicals cause blood vessels to leak fluid into tissues causing the swelling called inflammation.
After the inflammation has occurred, the white blood cells produce chemicals as well which are
released into the infected tissues or the circulating blood as a way of immune response, however,
this increases blood flow to the infected area instead resulting into redness and warmth.
In the case scenario of Mrs. Gina Bacci, the following describes her post-operative wound
status; Island film dressing along the incisional wound and wet dressing from serous exudate
shows that the wound is oozing. The wound also has some dehiscence along the suture line, the
wound has a sloughing tissue, warm surrounding skin, dark pink surrounding skin and lastly the
wound surrounding is painful upon touching. The exudate is normally a liquid fluid produced by
the body and in this case, is due to the post-operative surgical infection. Its an inflammatory
liquid leaking between cells and has been filtered from the circulatory system into areas of

inflammation and plays an important role in wound healing by providing a moist wound bed and
supplying necessary nutrients required for quick wound healing. Normal serous exudates can
indicate progressive wound healing whereas abnormal or purulent effluent serous exudates
which are normally yellow, grey or green shows invasion of an infection in the surgical site. The
wound dehiscence along the incisional wound indicates a surgical complication whereby the
wound ruptures along the surgical incision (Arterburn & Courcoulas, 2014). and this can be as a
result of the operation being done to an increased age patient, a diabetic patient, client with
obesity or poor knotting of the stitches and trauma to the wound after the surgery. The slough of
the wound is a result of the inflammatory phase during wound healing. It is comprised of dead
white blood cells, fibrin, cellular debris, and liquefied devitalized tissues. This cellular debris
when forced out onto the wound surface that's when it can be seen as a slough. The wound bed
has dead or non-viable tissue, when the slough is moist it helps in shifting and shading the dead
tissue. When the slough dries it becomes sticky and requires a helping hand for the natural
debridement process. The warm surrounding is due to an increased amount of blood flowing to
the infected area more compared to the surrounding area. The skin surrounding the wound start
turning pink once the scab forms and the body’s immune system starts to protect the wound from
superficial infection. Blood vessels ended up opening in the infected area so that blood can bring
oxygen and nutrients to the healing wound. Oxygen is among the necessary requirements of
wound healing (Pierpont, et.al 2014). Lastly, the surgical site which is inflamed is likely to be
painful too especially during and after touching. some chemicals are released, these chemicals
stimulate nerve endings making the area more sensitive. Hence can be painful upon touching.