Complications of Wound Healing Flashcards
What are some common wound problems?
Haemorrhage, Oedema, Seroma, Superficial infection, Abscess, Deep infection, Suture reaction, Lick irritation, Suture Sinus, ischaemia, dehiscence, chronic fistulae
What are the methods of wound evaluation?
clinical exam
observation
palpation
lab evaluation
What are signs of systemic illness that can be picked up on clinical exam?
fever, dullness, depression, inappetence, V, D, etc., tachycardia, hypotension, hypoglycaemia
What wound observations should be made?
Colour, presence & character of discharge, deformities or swelling, approximation of wound edges, any missing sutures?
What are signs of complications that may be noticed when palpating a wound?
heat, pain, fluid accumulation, pitting oedema, defect in tissue layers, abnormal texture
What are clinical signs of haemorrhage?
tachycardia, lowered BP/hypotension, pale MM, lethargy
What is specific to sight hounds in terms of wound healing?
Delayed post-operative bleeding 36-48 hours after surgery due to enhanced fibrinolysis and weaker clot strength leading to cutaneous bruising from the Sx wound, haemorrhagic discharge, skin loss
What drug should be given pre-operatively or intra-operatively to a sighthound to prevent delayed post-op bleeding?
Tranexamic acid 10 mg/kg TID prior to Sx or IV slowly
If Tranexamic acid is injected IV too quickly, what can occur?
Emesis
What does tranexamic acid do?
decrease fibrinolysis and increase clot strength
How do you treat a scrotal haematoma?
Scrotal ablation as needed
local txt (warm compress) &/or antimicrobials
What cautions are important to remember about scrotal haematomas?
painful
may progress to necrosis
How can oedema be treated?
Prevention/decresed by cold in first 48 hours, then warmth after first 48 hrs
Treat w/ warm compress to stimulate local circulation and help mobilize fluid
Oedema can be an early sign of…
wound infection or deep infection
How can you prevent seromas?
Limit dead space –> anchor SQ tissue to the abdominal wall
What is important to remember about seromas?
Do NOT Tap seromas - they are sterile and tapping can introduce infection
How do you differentiate a seroma from haemorrhage or abscesses?
Paracentesis
Watery blood (PCV <5%, few WBCs)
Pinkish fluid leaking out, low PCV, etc –> not necessarily infection
How do you tell a seroma from an abscess on ultrasound?
Seroma - normal, clear black space
Abscess - Hyperechoic (debris present)
What are characteristics of a superficial skin infection?
pustules or crusts
How do you prevent clipper injury?
Check clipper blade before any clipping
Proper technique
Avoid pre-clipping due to increased incidence post-op wound infection
Clip at induction to decrease risk of bacterial infection prior to Sx
What are some forms of deep infection?
Septic peritonitis, septic arthritis, osteomyelitis
What is septic peritonitis?
Free fluid in the abdomen –> infection in the abdominal cavity
what lab results could suggest a septic peritonitis?
high lactate, low glucose
Septic peritonitis is considered what kind of condition?
Life-threatening
What are the most common bacteria that cause septic arthritis?
S. intermedius
S. aureus
B-hemolytic Strep spp.
What bacteria are common in feline septic arthritis?
Pasteurella multocida
Bacteroides spp.
How can septic arthritis develop?
Haematogenous
Direct penetration
Local spread from adjacent tissues (osteomyelitis)
What clinical signs might be seen in septic arthritis?
turbid, purulent synovial fluid, less viscous
Increased WBC
Neutrophilic inflammation on cytology
How can osteomyelitis develop?
Haematogenous
Iatrogenic
Spontaneous inoculation of infectious agents into traumatic or Sx wounds
Why is osteomyelitis difficult to treat?
Biofilm from the bacteria develops and the infection will keep returning following treatment with antibiotics
What are signs of lick irritation?
bright red, shiny skin surface
Along wound edges/IV catheter signs
Possible skin suture loss
What are signs of skin ischaemia?
Purplish to black discoloration of the skin
Skin becomes hard & dry
Does not bleed, does not cause discomfort when cut b/c dead tissue
how do you treat skin ischaemia?
Debride dead skin & treat as an open wound
What are possible causes of skin ischaemia?
excessive undermining of skin edges, infection, abscessation
What are some important things to remember regarding dehiscence?
Avoid sampling - high risk
U/s always
requires surgical repair
