Lecture 3: Wound Complications

Question 1

what does SSI stand for?

Answer 1

surgical site infection

Question 2

what are the 3 things that contribute to SSI risk?

Answer 2

procedure, host, and microbe

Question 3

What are some examples of “host” risk factors?

Answer 3

age, nutritional status. systemic disease, infection, immunosuppression

Question 4

What are some examples of Microbe risk factors?

Answer 4

how virulent the microbe is, antimicrobial resistance, presence of foreign material at the site, host site depepdent

Question 5

what are some exmaples of surgicalrisk factors?

Answer 5

sx duration, aspetic technique, foreign material, surgical technique, emergency procedures

Time, trash, trauma

Question 6

List the 7 steps of Halstead’s Principles of Surgery

Answer 6

Gentle Tissue Handling

Hemostasis

Preservation of blood supply

strict aseptic technique

minimize tension on tissues

accurate apposition of tissues

eliminate deadspace

Question 7

What is a prophylactic?

Answer 7

given pre op and possible intra op to prevent establishment of infection

Question 8

what is a therapeutic drug?

Answer 8

used post op when indicated to treat an established infection

Question 9

When is it appropriate to use a prophylactic?

Answer 9

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

Question 10

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

Answer 10

1

maintain levels

24

Question 11

what are symptoms associated with an SSI?

Answer 11

heat, swelling, pain, redness, exudate within 30 days of sx or 1 year if implants

Question 12

what are the 3 depths an SSI can be?

Answer 12

superficial: skin and subcutaneous tissue

deep incisional: muscle and fascia

organ or space: peritoneum, pleural space, etc

Question 13

what is a complicated wound?

Answer 13

a wound that fails to heal as expected due to complicating factors which are in 3 categories: wound, patient, environment

Question 14

What are some examples of wound factors that would cause dehiscence or delayed wound healing?

Answer 14

infection, excessive tension, seroma or hematoma formation, non viable tissue, poor perfusion, saliva or synovial fluid in wound, foreign bodies, neoplasia

Question 15

what are some patient factors that may cause wound dehiscence or delayed wound healing?

Answer 15

systemic disease, nutrition, medications, neoplasia

Question 16

what are some examples of environmental factors that delay wound healing/cause wound dehiscence?

Answer 16

post op wound trauma, movement

Question 17

what are the signs of impeding dehiscence?

Answer 17

excessive swelling or fluid accumulation, discharge, suture failure, tissue necrosis

Question 18

Name some strategies to prevent wound dehiscence.

Answer 18

prevent contamination, minimize tension, immobilize joints and minimize movement, manage dead space, nutrition, medications, reduce swelling, protect from trauma

Question 19

What are some ways in which you can diagnostically approach a complicated wound to see what went wrong?

Answer 19

history and examination, wound exploration, imaging, biopsy and histopathology, impression smears, culture

Question 20

true or false: square wounds heal better than round wounds

Answer 20

true!

Question 21

what are ways in which you can prevent and treat wound contracture?

Answer 21

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

Question 22

how do you treat hyperproliferative wound healing/pathologic scarring?

Answer 22

remove the excessive tissue (like proud flesh, excessive granulation tissue), local anti-inflammatory, reduce inflammatory stimuli, may need skin grafting