Colonized, critically colonized and infected wounds: differentiation using clinical and microbiological and morphological methods of investigation

Abstract

Objective. To analyze the clinical and microbiological and morphological features of wounds of different duration, allowing to differentiate the stages of the infectious process and to determine recommendations for further tactics of preoperative preparation.Materials and methods. Clinical and microbiological and morphological assessment of the state of acute and chronic wounds in 313 patients was performed.Results. Colonized wounds were characterized by the presence of pathological signs (atrophy, cicatricial changes) in fine-grained granulations, the frequency of which increased from 38.5% for wounds lasting 22–28 days up to 85.1% for wounds lasting more than 2 months (χ2 = 14.0 ; p=0.003). Infected wounds were more often detected at terms of 22–28 days (24.6%, vs 3.9% for wounds more than 2 months old, χ2=40.51; p<0.001). Critically colonized wounds made up with coarse-grained granulations were detected at all stages of wound existence (from 21.6 to 32.8%). The analysis of biopsy specimens revealed the initial signs of proliferation disorders in 22-28 day wounds, which justifies the need to classify them as chronic. Second phase reparation failure was detected in all cases of chronic wounds; the severity of the signs of purulent inflammation increased depending on the stage of the infectious process.Conclusion. Differentiation of the stages of the infectious process in wounds using the clinical and microbiological and morphological research methods is necessary for the determination of the indications for the use of local wound debridement and systemic antibiotic therapy at the stage of wound preparation for plastic closure.