Lecture 3: Wound Complications Flashcards
what does SSI stand for?
surgical site infection
what are the 3 things that contribute to SSI risk?
procedure, host, and microbe
What are some examples of “host” risk factors?
age, nutritional status. systemic disease, infection, immunosuppression
What are some examples of Microbe risk factors?
how virulent the microbe is, antimicrobial resistance, presence of foreign material at the site, host site depepdent
what are some exmaples of surgicalrisk factors?
sx duration, aspetic technique, foreign material, surgical technique, emergency procedures
Time, trash, trauma
List the 7 steps of Halstead’s Principles of Surgery
Gentle Tissue Handling
Hemostasis
Preservation of blood supply
strict aseptic technique
minimize tension on tissues
accurate apposition of tissues
eliminate deadspace
What is a prophylactic?
given pre op and possible intra op to prevent establishment of infection
what is a therapeutic drug?
used post op when indicated to treat an established infection
When is it appropriate to use a prophylactic?
in cases where an SSi would be a disaster, like in a total hip replacement, fracture repair with implants, abdominal sx, anything other than a clean sx
If you decided to use a prophylactic, it should be given in high levels ____ hour(s) before sx starts. You also need to _____ during sx. You don’t need it more than ____ hours post op
1
maintain levels
24
what are symptoms associated with an SSI?
heat, swelling, pain, redness, exudate within 30 days of sx or 1 year if implants
what are the 3 depths an SSI can be?
superficial: skin and subcutaneous tissue
deep incisional: muscle and fascia
organ or space: peritoneum, pleural space, etc
what is a complicated wound?
a wound that fails to heal as expected due to complicating factors which are in 3 categories: wound, patient, environment
What are some examples of wound factors that would cause dehiscence or delayed wound healing?
infection, excessive tension, seroma or hematoma formation, non viable tissue, poor perfusion, saliva or synovial fluid in wound, foreign bodies, neoplasia
what are some patient factors that may cause wound dehiscence or delayed wound healing?
systemic disease, nutrition, medications, neoplasia
what are some examples of environmental factors that delay wound healing/cause wound dehiscence?
post op wound trauma, movement
what are the signs of impeding dehiscence?
excessive swelling or fluid accumulation, discharge, suture failure, tissue necrosis
Name some strategies to prevent wound dehiscence.
prevent contamination, minimize tension, immobilize joints and minimize movement, manage dead space, nutrition, medications, reduce swelling, protect from trauma
What are some ways in which you can diagnostically approach a complicated wound to see what went wrong?
history and examination, wound exploration, imaging, biopsy and histopathology, impression smears, culture
true or false: square wounds heal better than round wounds
true!
what are ways in which you can prevent and treat wound contracture?
close by primary closure or delayed primary closure whenever possible, re-evaluate the wound, physiotherapy and early return to motion for wounds near joints, scar revision procedures as treatment
how do you treat hyperproliferative wound healing/pathologic scarring?
remove the excessive tissue (like proud flesh, excessive granulation tissue), local anti-inflammatory, reduce inflammatory stimuli, may need skin grafting
