Post-traumatic infections of the extremities

Abstract

The extent of the development of post-traumatic infections of the extremities depends upon the nature of the wound and the type of organisms introduced. These injuries may be classified as abrasions, incised, punctured, lacerated, contused and gunshot wounds. A staphylococcic or streptococcic infection may develop following abrasions but these are ordinarily of little consequence. The development of infection after incised, punctured or lacerated wounds causes little systemic reaction if the lesion is superficial. However, in deep wounds in which the fascia and muscles have been penetrated, the introduction of streptococcus, staphylococcus and anaerobic organisms is productive of more acute symptoms. The most serious type of infection following a deep puncture is tetanus, characterized by pain and spasm of the masseters, trismus, opisthotonos, convulsions and death. Tetanus antitoxin and combined tetanus and polyvalent gas gangrene antitoxin should be administered routinely to all patients with incised, lacerated or punctured wounds. The severest type of infection follows gunshot wounds because they represent a combination of punctured, lacerated and contused wounds with the addition of a foreign body. Under anaerobic conditions, the deep implantation of various organisms, extensive tissue damage and the presence of foreign bodies encourage the development of gas gangrene. This picture is characterized by intense pain for some distance about the wound, rapid pulse rate out of proportion to the moderate temperature, brick-red serosanguineous discharge and distinct, pungent, nauseating odor. The prophylactic measures of immediate implantation of sulfathiazole as a first aid measure, early débridement and reimplantation of sulfathiazole will prevent the development of this dreaded disease.