CBD Study MD2 Flashcards
What are the types of post-operative fluid collections?
- Haematomas
- Seromas
- Lymphoceles
Why do large fluid collections prolong the recovery process?
Potential for wound breakdown
Infection risk (avenue for bacterial seeding of a joint replacement –> periprosthetic joint infection)
What are some RF for developing a post-op fluid collection?
Multiple fascial planes
Revision surgery
Persistent peri-wound pressure
Inadequate haemostasis
Trauma in acute post-op period
What surgeries are most likely to result in a seroma post-op collection?
Extensive soft tissue procedures
When do seroma post-op collections usually develop?
Within 2 weeks after surgery or trauma
What causes a haematoma post-op collection?
Arterial or venous insult that permits blood products to permeate the potential space within the muscle, between fascial layers or within subcutaneous tissues
When do haematomas usually develop?
48-72 hours after surgery or trauma
What is a serious complication of haematoma?
Compartment syndrome: critical pressure increase within a confined compartmental space (often from blood) –> pressure causes veins to be compressed, increases the hydrostatic pressure so fluid moves out of veins and into compartment
Need an urgent fasciotomies and you leave the skin incisions open for 24-48 hours
How are haematomas different to seroma?
THe blood products contain copious amounts of inflammatory mediators that can potentiate mass effect and inflammation around the area of surgery
Often a firm mass
How do seromas present?
Develop 2-4 weeks after surgery
Soft tissue swelling with accompanying soft tissue induration, warmth and erythema in proximity to the incision
Fluid collection is usually superficial to muscular fascia and most prominent in subcutaneous tissues
How do haematomas present?
Within days of surgery
Can occur in subcutaneous tissues but also tend to develop deeper in fascia and muscle
Patients may complain of pain
What are RFs for development of haematoma from THR?
Blood loss
Administration of fresh blood
Perioperative anticoagulation
–> make you suspicious of haematoma over seroma
How do you ix post-op collections?
USS!!
- Can be difficult to differentiate seroma from haematoma
How do you manage a post-op collection?
Best management is prevention!!
Negative pressure wound therapy: use a vacuum-assisted closure dressing for several days after surgery
Aspiration: to diagnosis and decompress
- Rule out infection
- Use compression wrap afterwards
- Good for small to moderate sized
Surgical strategies: sometimes need open irrigation and debridement
How do you prevent post-op collections?
Sharp soft tissue dissection
Appropriate haemostasis
Avoiding multiple large fascial planes
Compare and contrast haematomas and seromas:
