====== Superficial wound infection ======

===== Management =====

1. [[culture]] the [[wound]] and/or any [[purulent]] [[drainage]]

2. start the patient empirically on [[vancomycin]] plus [[cefepime]] or [[meropenem]]

3. modify [[antibiotic]]s appropriately when [[culture]] and [[sensitivity]] results available

4. [[Debridement]] of all necrotic and devascularized tissue and any visible [[suture]] material (foreign
bodies). Superficial wound infections may be debrided in the office or treatment room, deep
infections must be done in [[OR]]

5. shallow defects may be allowed to heal by secondary intention, and the following is one possible
regimen

a) pack the wound defect with 1/4” [[Iodophor]]®[[gauze]]

b) dressing changes at least BID (for hospitalized patients, change q 8hrs), remove and trim≈
0.5–1” of packing with each dressing change

● while the wound is purulent, utilize 1/2 strength [[Betadine]]® wet to dry [[dressing]]s

● when purulence subsides, switch to [[normal saline]] wet to dry

c) antibiotics, may be useful as an adjunct to wound treatment initially, switch to oral antibiotics as early as possible, a duration of 10–14 days total is probably adequate if local wound care is being done

6. some prefer to close the wound by primary intention, it is critical that there be no tension on the wound for healing to occur. Some close over an irrigation system or antibiotic beads. Retention sutures may be helpful

7. with large defects or when [[bone]] and/or [[dura]] becomes exposed, the use of a [[muscle flap]] (often performed by a plastic surgeon) is probably required

8. [[CSF leakage]] requires exploration in the [[OR]] with [[watertight dural closure]] to prevent [[meningitis]]