complications of soft tissue surgery

Question 1

what is the speed of healing in the intestine?

Answer 1

14 days - for wound strength to reach normal levels

Question 2

what is the speed of healing of the bladder?

Answer 2

21-28 days to regain nearly 100% strength

Question 3

when is the intestine and bladder most likely to breakdown (dehise)?

Answer 3

72-96hours following surgery (lag phase of healing) (the fibrin seal is broken down my macrophages but is still to early for collagen to bind the wound together)
the suture is providing all of the support and strength

Question 4

what does dehiscence mean?

Answer 4

wound breakdown

Question 5

what checks should be undertaken at the end of an operation?

Answer 5

• Check integrity of repair: gut , bladder
• Check for bleeding
• Lavage and suction - to reduce chances of infection from contamination
• Count your swabs
• Change gloves or Change instruments? - if high contamination

Question 6

what are the signs of an animal developing an wound infection/peritonitis/uroabdomen?

Answer 6

fine for the first day after surgery then:
- lethargy
- anorexic
- pyrexia
- vomiting (bowel or bladder opperation)
- abdominal painfull swelling (abdominal gaurding)

Question 7

what diagnostic tests would you do if you suspect breakdown of intestine or bladder after surgury?

Answer 7

radiograpy and abdo ultrasound and then an abdo tap

Question 8

what can you see on this radiograph?

Answer 8

• loss of serosal detail that suggests some peritoneal fluid present
• gass density in the dorsal aspect of the abdomen, suggesting precence of free gass in abdomen, which could be associated with gas froming organisms that are now within peritoneal cavity

Question 9

what can you see withing this abdominal ultrasound?

Answer 9

• presence of free fluid between liver lobes and the liver lobe and kidney of the LHS

Question 11

what does what does serosanguinous mean?

Answer 11

contains both blood and serum

Question 12

what does what does sanguinous mean?

Answer 12

contains blood

Question 13

what is this showing? how would you treat this?

Answer 13

peritonitis - if caused by break down of wound/suture would perform an enterectomy and then peritoneal lavage

Question 14

what will uroabdomen look like on bloodwork?

Answer 14

hypokalemic as cannot urinate it out

Question 15

what can you see on this contrast radiograph?

Answer 15

contrast in the urethra, bladder (some in the vagina - none probalmatic), and leakage into the abdomen

Question 16

when reclosing the bladder after breakdown of the surgical wound what would you place and why?

Answer 16

a tube cystotomy - through the outside abdominal wall so the bladder can be drained to avoid pressure build up which would breakdwon the new closure

Question 17

what is the critial (suture holding) layer of the linea alba?

Answer 17

external rectus sheath
the external and internal leaf mack up the rectus sheath cranial to the umbilicus and this is very obvious. caudal to the umbilicus there is only the external leaf and this is harder to locate in some patients

Question 18

why should you not suture through the rectus muscle of the abdomen?

Answer 18

no suture holding strength and will cause discomfort to the patient

Question 19

how do we close the linea alba and why do we do this?

Answer 19

Continuous suture patterns preferable:
* even distribution of tension along length of closure
* more rapid closure
* less suture material (= less foreign material)
* 6 throws at each end (sliding self-locking knot and Abderdeen knot)

Absorbable monofilament; e.g, polydioxanone or polyglyconate
e.g. commonly either 2/0 or 0 (dogs) or 3/0 or 2/0 (cats)

Question 20

what knot is used at the start of a continuous suture?

Answer 20

sliding self-locking knot

Question 21

what knot is used at the end of a continuous suture?

Answer 21

aberdeen knot

Question 22

what is this an example of?

Answer 22

eviseration - intestial content coming through the wound - contamination risk!

Question 23

what is the suture holding layer in the intestine and bladder?

Answer 23

submucosa