Complications of Wound Healing

Question 1

What are some common wound problems?

Answer 1

Haemorrhage, Oedema, Seroma, Superficial infection, Abscess, Deep infection, Suture reaction, Lick irritation, Suture Sinus, ischaemia, dehiscence, chronic fistulae

Question 2

What are the methods of wound evaluation?

Answer 2

clinical exam
observation
palpation
lab evaluation

Question 3

What are signs of systemic illness that can be picked up on clinical exam?

Answer 3

fever, dullness, depression, inappetence, V, D, etc., tachycardia, hypotension, hypoglycaemia

Question 4

What wound observations should be made?

Answer 4

Colour, presence & character of discharge, deformities or swelling, approximation of wound edges, any missing sutures?

Question 5

What are signs of complications that may be noticed when palpating a wound?

Answer 5

heat, pain, fluid accumulation, pitting oedema, defect in tissue layers, abnormal texture

Question 6

What are clinical signs of haemorrhage?

Answer 6

tachycardia, lowered BP/hypotension, pale MM, lethargy

Question 7

What is specific to sight hounds in terms of wound healing?

Answer 7

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

Question 8

What drug should be given pre-operatively or intra-operatively to a sighthound to prevent delayed post-op bleeding?

Answer 8

Tranexamic acid 10 mg/kg TID prior to Sx or IV slowly

Question 9

If Tranexamic acid is injected IV too quickly, what can occur?

Answer 9

Emesis

Question 10

What does tranexamic acid do?

Answer 10

decrease fibrinolysis and increase clot strength

Question 11

How do you treat a scrotal haematoma?

Answer 11

Scrotal ablation as needed
local txt (warm compress) &/or antimicrobials

Question 12

What cautions are important to remember about scrotal haematomas?

Answer 12

painful
may progress to necrosis

Question 13

How can oedema be treated?

Answer 13

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

Question 14

Oedema can be an early sign of…

Answer 14

wound infection or deep infection

Question 15

How can you prevent seromas?

Answer 15

Limit dead space –> anchor SQ tissue to the abdominal wall

Question 16

What is important to remember about seromas?

Answer 16

Do NOT Tap seromas - they are sterile and tapping can introduce infection

Question 17

How do you differentiate a seroma from haemorrhage or abscesses?

Answer 17

Paracentesis
Watery blood (PCV <5%, few WBCs)
Pinkish fluid leaking out, low PCV, etc –> not necessarily infection

Question 18

How do you tell a seroma from an abscess on ultrasound?

Answer 18

Seroma - normal, clear black space
Abscess - Hyperechoic (debris present)

Question 19

What are characteristics of a superficial skin infection?

Answer 19

pustules or crusts

Question 20

How do you prevent clipper injury?

Answer 20

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

Question 21

What are some forms of deep infection?

Answer 21

Septic peritonitis, septic arthritis, osteomyelitis

Question 22

What is septic peritonitis?

Answer 22

Free fluid in the abdomen –> infection in the abdominal cavity

Question 23

what lab results could suggest a septic peritonitis?

Answer 23

high lactate, low glucose

Question 24

Septic peritonitis is considered what kind of condition?

Answer 24

Life-threatening

Question 25

What are the most common bacteria that cause septic arthritis?

Answer 25

S. intermedius
S. aureus
B-hemolytic Strep spp.

Question 26

What bacteria are common in feline septic arthritis?

Answer 26

Pasteurella multocida
Bacteroides spp.

Question 27

How can septic arthritis develop?

Answer 27

Haematogenous
Direct penetration
Local spread from adjacent tissues (osteomyelitis)

Question 28

What clinical signs might be seen in septic arthritis?

Answer 28

turbid, purulent synovial fluid, less viscous
Increased WBC
Neutrophilic inflammation on cytology

Question 29

How can osteomyelitis develop?

Answer 29

Haematogenous
Iatrogenic
Spontaneous inoculation of infectious agents into traumatic or Sx wounds

Question 30

Why is osteomyelitis difficult to treat?

Answer 30

Biofilm from the bacteria develops and the infection will keep returning following treatment with antibiotics

Question 31

What are signs of lick irritation?

Answer 31

bright red, shiny skin surface
Along wound edges/IV catheter signs
Possible skin suture loss

Question 32

What are signs of skin ischaemia?

Answer 32

Purplish to black discoloration of the skin
Skin becomes hard & dry
Does not bleed, does not cause discomfort when cut b/c dead tissue

Question 33

how do you treat skin ischaemia?

Answer 33

Debride dead skin & treat as an open wound

Question 34

What are possible causes of skin ischaemia?

Answer 34

excessive undermining of skin edges, infection, abscessation

Question 35

What are some important things to remember regarding dehiscence?

Answer 35

Avoid sampling - high risk
U/s always
requires surgical repair