| Duration after wounding (without antimicrobial treatment) |
Events |
Outcome |
Role of LAD |
| <6-8 hrs |
Environment
microorganisms reach
over the wound |
Wound contamination |
Barrier by polythene andaseptic LAD wash usingnegative pressurereduces chances ofcontamination |
| 6-8 hrs |
Microorganisms starts
growing over the wound |
Wound colonization,
production harmful
bacterial
enzymes/toxins
and formation of biofilm
may start |
LAD wash andintermittent negativepressure every 4thhourly reduces chancesof colonization, removesharmful chemicals andbreaks biofilm barrier |
| After 6-8 hrs |
Microorganisms starts
invading the viable
tissue |
Wound invasion/wound
sepsis (rapidity of
invasion depends on
quantitative bacterial
count and virulence) |
Intermittent negativepressure every 4th hourly reduces chancesof invasion by reducing
count and providingalternate strongernegative drainingchannel to lymphaticsand venules |
| Late events |
A. Proinflammatory
cytokines produced in
the wound is absorbed
in systemic circulation
B. Microorganism gainsaccess to circulation
C. Bacteria startsproliferating in systemiccirculation
D. Hypotension
Produced
E. Organ functionsderanged |
SIRS
Bacteremia
Sepsis
Severe sepsis
Organ dysfunction/
Failure |
Leech effect of LADreduces chances ofSIRS and organ failure(continuous suction
may be done if required)(Bacteria may gainaccess to systemiccirculation through otherroute e.g. bacterial
translocation, urinary
tract, cheat infection) |
