complications of soft tissue surgery Flashcards
Describe intestinal healing
relatively fast
wound strength back to normal 14 days post-suturing
Describe urinary bladder healing
relatively fast
wound strength back to normal 21-28 days post-suturing
When are intestine & urinary bladder most likely to breakdown (dehisce)?
During first 72-96 hours (within lag phase)
During this period, all support & strength of wound comes from sutures
Can be due to comorbidities, poor suturing, infection
Lag phase: fibrin seal is being broken down by macrophages but still too early for collagen to bind wound together
What checks do we need to undertake at end of operation to prevent dehiscence?
Check integrity of repair:
- gut
- bladder
Check for bleeding
Lavage and suction if there was any contamination
Count your swabs
Change gloves?
Change instruments?
What signs would an animal show if they were developing postoperative complications (wound infection, peritonitis, uroabdomen) and what tests would you do to confirm?
signs:
- Fine in first day or so
- Then dull, lethargic, anorexic, vomiting, diarrhoea, painful on palpation, abdominal guarding, pyrexia
Tests:
- Radiography
- Abdominal ultrasound
- Abdominal tap
What is going on here?
enterectomy dehiscence
Bruising of abdominal wall, distended and painful
Inflammatory process is affecting muscle & subcutaneous layer
May be leakage of contaminated material through linea alba that is pooling in subcutaneous space
What is going on here
Left:
- Degree of loss of cirrhosal detail – suggests peritoneal fluid present
- Gas density in dorsal abdomen – presence of free gas in abdomen
Right:
- Free fluid between liver lobes & liver lobe & kidney – free peritoneal fluid
What do these suggest
Peritonitis
Blood in fluid
Lots of toxic neutrophils & some bacteria (arrow) in cytoplasm of neutrophils
What can you see here
Generalised peritonitis
Clear enterotomy dehiscence
No point trying to repair, remove piece instead
then perform peritoneal lavage
- Flush abdomen with large volume of warm sterile isotonic solution to dilute contamination
What can you seen in this case of suspected Urinary bladder dehiscence leading to uroabdomen
Likely hyperkalaemic
Retrograde positive contrast urethrogram
Leak from bladder repair into peritoneal space
Describe the closure of the linea alba
Reconstruct original anatomy
External rectus sheath is the critical layer
Cranial abdomen:
- Rectus sheath made up of internal & external leaves so very obvious & robust
Caudal abdomen:
- Only external leaf so more difficult to locate
Continuous suture pattern
- even distribution of tension along length of closure
- rapid closure
- less suture material (= less foreign material)
- 6 throws at each end
Absorbable monofilament
- e.g. polydioxanone
- 2/0 or 0 dogs or 3/0 or 2/0 cats
What is the suture holding layer in any lumen surgeries
submucosa
