Post op wound complications

Question 1

Q: What are postoperative wound complications?

Answer 1

A: Disruptions of anatomical layers post-surgery, including evisceration, dehiscence, seroma, hematoma, fistula, and wound infections.

Question 2

Q: What are some risk factors for postoperative wound complications?

Answer 2

A: Smoking, malnutrition, chronic steroid use, diabetes, anemia, ascites, coagulopathy, and anticoagulation.

Question 3

Q: How do you assess a patient with suspected postoperative wound complications?

Answer 3

A: Perform an ABCDE assessment to determine stability, then provide acute management for unstable patients and supportive care for stable patients.

Question 4

Q: What steps are involved in supportive care for stable patients with postoperative wound complications?

Answer 4

A: Obtain IV access, fluid resuscitation, administer pain medication, wound care, and possibly NPO status with nutritional support.

Question 5

Q: What are the clinical features of evisceration?

Answer 5

A: History of straining or popping sensation, complete opening of all layers of an incision with abdominal contents spilling out.

Question 6

Q: What diagnostic steps should be taken for suspected evisceration?

Answer 6

A: Immediate visual diagnosis; it’s a surgical emergency requiring urgent surgical intervention.

Question 7

Q: What are the clinical features of dehiscence?

Answer 7

A: History of previous infection or fluid collection, increased drainage, sudden pain, partial or complete opening of the incision without abdominal contents spilling out.

Question 8

Q: How do you diagnose dehiscence?

Answer 8

A: Labs (CBC, ESR, CRP, BMP, albumin), imaging (ultrasound, CT scan), and physical exam findings.

Question 9

Q: What are the clinical features of a seroma?

Answer 9

A: History of surgical drains, coagulopathy, or anticoagulation, pain, reduced joint movement, fluctuant incisional swelling.

Question 10

Q: How do you diagnose a seroma?

Answer 10

A: Labs (CBC, ESR, CRP, BMP, albumin) are usually normal; imaging shows an anechoic fluid collection without walls.

Question 11

Q: What are the clinical features of a hematoma?

Answer 11

A: History of coagulopathy or anticoagulation, pain, reduced function, incisional swelling, and possible skin discoloration.

Question 12

Q: How do you diagnose a hematoma?

Answer 12

A: Labs (CBC with decreased hemoglobin/hematocrit), imaging shows a well-defined heterogeneous collection.

Question 13

Q: Evisceration: Time of Onset, Clinical Features, Diagnosis, Management, Treatment

Answer 13

Time of Onset: Immediate postoperative period
Clinical Features: History of straining or popping sensation, complete opening of all layers of an incision with abdominal contents spilling out
Diagnosis: Visual diagnosis, history and physical exam findings
Management: Immediate surgical intervention
Treatment: Surgical repair, sterile dressings to cover exposed contents, broad-spectrum antibiotics

Question 14

Q: Dehiscence: Time of Onset, Clinical Features, Diagnosis, Management, Treatment

Answer 14

A:

Time of Onset: Within days to weeks post-surgery
Clinical Features: Previous infection or fluid collection, increased drainage, sudden pain, partial or complete opening of the incision without abdominal contents spilling out, possible bulging or incisional swelling
Diagnosis: Labs (CBC, ESR, CRP, BMP, albumin), imaging (ultrasound, CT scan)
Management: Supportive care, wound care, possible surgical intervention
Treatment: Surgical repair, infection control, wound care

Question 15

Q: Seroma: Time of Onset, Clinical Features, Diagnosis, Management, Treatment

Answer 15

Time of Onset: Days to weeks post-surgery
Clinical Features: History of surgical drains, coagulopathy, or anticoagulation, pain, reduced joint movement, fluctuant incisional swelling
Diagnosis: Labs (CBC, ESR, CRP, BMP, albumin; usually normal), imaging (ultrasound showing an anechoic fluid collection without walls)
Management: Monitoring, aspiration if necessary
Treatment: Aspiration, compression dressings, monitoring for infection

Question 16

Q: Hematoma: Time of Onset, Clinical Features, Diagnosis, Management, Treatment

Answer 16

A:

Time of Onset: Days to weeks post-surgery
Clinical Features: History of coagulopathy or anticoagulation, pain, reduced function, incisional swelling, possible skin discoloration
Diagnosis: Labs (CBC with decreased hemoglobin/hematocrit), imaging (ultrasound, CT scan showing a well-defined heterogeneous collection)
Management: Monitoring, possible surgical drainage
Treatment: Drainage, correction of coagulopathy, pain management

Question 17

Q: Fistula: Time of Onset, Clinical Features, Diagnosis, Management, Treatment

Answer 17

A:

Time of Onset: Weeks to months post-surgery
Clinical Features: Chronic drainage at or near incision site, history of deep infection or abscess, continuous drainage, tract formation, skin changes, elevated temperature
Diagnosis: Labs (CBC, ESR, CRP, BMP, albumin), imaging (ultrasound, CT scan, fistulogram showing fluid collection or aberrant communication)
Management: Nutritional support, wound care
Treatment: Surgical repair, antibiotics if infected, management of underlying conditions

Question 18

Q: Superficial Wound Infection: Time of Onset, Clinical Features, Diagnosis, Management, Treatment

Answer 18

A:

Time of Onset: Days to weeks post-surgery
Clinical Features: Rubor, calor, tumor, dolor, functio laesa, purulent drainage, fever, tachycardia, tachypnea
Diagnosis: Labs (CBC, ESR, CRP, BMP, albumin, wound and blood cultures), imaging usually not required unless ruling out fluid collection
Management: Wound care, antibiotics
Treatment: Antibiotics, wound debridement

Question 19

: Deep Wound Infection/Abscess: Time of Onset, Clinical Features, Diagnosis, Management, Treatment

Answer 19

Time of Onset: Weeks post-surgery
Clinical Features: Purulent drainage, fever, rubor, calor, tumor, dolor, functio laesa, surrounding edema, soft tissue stranding or cobblestoning
Diagnosis: Labs (CBC, ESR, CRP with positive cultures), imaging (ultrasound, CT scan showing fluid collections, edema, and abscess)
Management: Surgical drainage, antibiotics
Treatment: Antibiotics, surgical drainage or debridement, management of underlying conditions