Clinical Management of Surgical Site Infections

Surgical site infection (SSI) in orthopaedic surgery is very badly experienced by the patient as well as his surgeon. Indeed, this complication suppresses the expected benefit of the surgical procedure causing sometimes serious morbidity that can threaten the functional prognosis of the concerned segment. It can even be life-threatening in patients with multiple comorbidities. Diagnosis of SSI as a first step of management can be easy when the clinical picture is complete as it can be difficult to carry in case of low virulent germs. The depth of the infection is also an important factor to define that can impact the surgeon decision. The main concern is always whether it is a superficial infection or a deep one coming into contact with the implant. In addition, management of fracture-related infection, prosthetic joint infection and SSI following spinal instrumentation surgery has each their own particularities, requiring to be approached differently. The ultimate goal is to eradicate the infection early enough before biofilm formation, which allows the device placed to be preserved and to avoid serious morbidity. In this chapter, clinical manifestations of SSIs, the risk factors incriminated and the particularities of their management in traumatology, prosthetic and spinal surgery are exposed.