The impact of nonwound site infection on surgical wound healing

Wound healing is the result of a complex synergistic series of biomolecular activity that can be altered by numerous factors. One such factor is infection. If the infection occurs at the surgical site, it is clear that the normal process is destroyed, interrupted or at best retarded. However, little is known of the effects of nonwound site infection on the healing process. This review evaluates and makes recommendations regarding the patient who presents with infection in another anatomic site, based on wound healing potential. THE DEVELOPMENT OF WOUND SITE INFECTION As many as 71% of all nosocomial infections occur in surgical patients, 40% of which occur at the postoperative wound site (1). The development of wound site infection depends on several factors, including: microbial pathogenicity, local and systemic host defenses, local environmental factors and surgical technique (2). Microbial pathogenicity can be considered the balance between host defenses and microbial virulence. This balance can be tipped by bacteria that are resistant to phagocytosis and/or intracellular lysozymes, or by microbes that produce exoor endotoxins. These toxins injure host cells directly or activate host mediators to cause damage. Local host defenses include epithelium, mucus membranes and local immunoglobulin A, whereas systemic host defenses include phagocytic cells, the humoral and cellular immune systems and molecular cascades.