'Be a Rambo' when treating wound infections. (Fully Open Wound Without Delay).

ST. Louis -- The key to successful management of surgical wound infections is aggressive action, Dr. Sebastian Faro emphasized at the 12th International Pelvic Reconstructive and Vaginal Surgery Conference.

"You've really got to be a Rambo here," according to Dr. Faro, professor of ob.gyn. and an infectious disease specialist at the University of Texas, Houston.

Early signs of wound infection include minor elevations in body temperature in the 99.8[degrees]-100.4[degrees] F range, a parallel increase in heart rate, an orange color to the skin, induration, edema, drainage, and erythema advancing from the incision. Pain in the wound is an ominous sign that can signal necrotizing fasciitis.

When he spots a patient with early signs of wound infection, he makes liberal use of ultrasound to determine if there is a loculated area of fluid collected in the wound, and to guide aspiration of a fluid sample for Gram staining and culture.

"If you take a 16-gauge needle and go right in through the incision line, there is no associated pain," he said at the meeting, also sponsored by the Society of Pelvic Reconstructive Surgeons.

A Gram stain takes 15 minutes to run. The results can be used to guide therapy. If the aspirated fluid is brownish in color and the Gram stain shows WBCs and no bacteria, think of ureaplasma or mycoplasma as likely pathogens.

With WBCs and gram-positive cocci in clusters, assume it's a staphylococcal infection until proven otherwise. Determination of antibiotic sensitivities becomes essential in this setting.