Post operative management Flashcards
Risk factors for post-op wound infections?
Contaminated operations Long procedures - more than 2 hrs Diabetes Obesity Smoking Immunosuppresion
Management of mild wound infections?
Mild = erythema, no fever.
Analgesia
Regular wound dressing
Oral abx
Management of severe wound infections?
Severe = discharge, fever, abscess present
Wound swabs
IV abx
Reopen wound if abscess present
Allow wound to heal by secondary intention
What is wound dehiscence?
Separation of a surgical wound - especially after abdominal surgery
Life-threatening post-op complication
How to manage wound dehiscence?
- Cover wound with WET sterile gauze (usually soaked in saline)
- Transfer to theatre for re-suturing
Aim of peri-operative abx?
Prevent post op wound infections
How to prevent post-op complications/enhance recovery?
Good prep for surgery (diet, exercise) Minimally invasive choice of surgery Adequate analgesia Good nutrition Early return to oral diet and fluid intake Early mobilisation Avoid drains, NG, early catheter removal Early discharge
Causes of post-op N+V?
Surgical procedure Anaesthetic Pain Opiate use/drugs Paralytic ileus Infection
RF for post-op N+V?
Female Hx of motion sickness or post op N+V Non-smoker Use of opiates post-op Younger age Use of volatile anaesthetics
Management of post-op N+V?
Anti-emetics
Minimise movements
IV fluids if dehydrated
Analgesia
Commonly used anti-emetic options for post-op N+V?
(I.e ones given on post op ward, not ones given as prophylaxis in op).
Ondansetron
Prochlorperazine
Cyclizine
Causes of post-op reduced urinary output?
Pre-renal - hypovolaemia - hypotension - dehydration Renal - acute tubular necrosis Post-renal - BPH - anticholinergics or alpha blockers (used as anasthetics) - pain - psychological inhibition - opiate analgesia
Causes of post-op pyrexia?
5Ws Wind - pneumonia, atelectasis Water - UTI Wound - infection Wonder drugs - anaesthesia Walking - DVT
also can be caused by developing abscess.
What post op complications can occur?
Anaemia Atelectasis Infections Wound dehiscence Ileus Haemorrhage DVT and PE Shock due to hypovolemia, sepsis, HF, Arrhythmias MI and stroke AKI Urinary retention Delirum
In a wound management how would you perform a systematic assessment of the wound? TIMES mnemonic
Tissue involved (viable or non viable)
Infection or inflammation
Moisture levels
Edge of the wound
Surrounding skin
What should you assess in terms of patient factors when thinking of wound management?
identify factors that are detrimental to wound healing.
Control or eliminate those factors as dressings do not heal wounds, the patient does
what are some different types of wounds?
MANY!
Simple uncomplicated wounds
large or complex wounds
infected wounds
necrotic wounds (with or without infection)
sloughy wounds
granulating wounds
epithelializing wounds.
General aims for wound management: wounds should be kept in what state to enable healing?
Clean
protected
environment to facilitate healing
What is negative pressure wound therapy ?
VAC - (vacuum assisted dressing) is trade name
Aids the haling of wounds
temporise them before formal reconstruction
How does negative pressure wound therapy aid healing ?
-ve pressure encourages blood supply, reduces oedema and don’t need lots of dressing changes.
encourages cell activity and perfusion, stimulates granulation tissue formation
sealed dressing covers the wound and set to negative pressure which removes exudate int o collecting canister.
What are contraindications for negative pressure wound therapy?
exposure of blood vessel or bowel
infection
significant tissue necrosis needing debridement.
What wounds is negative pressure wound therapy good for?
Larger wounds
In surgery how are most wounds managed ?
Secondary intention healing
or
primary closure
What is primary closure ?
Small wound with edges that can be easily opposed e.g. scalpel incision
4 stages: Haemostasis Inflammation proliferation remodelling
END RESULT - minimal scaring + complete return to function
What is secondary intention healing?
Side of wounds not opposed so healing occurs form base of wound upwards
4 stages: Haemostasis Inflammation proliferation remodelling
Myofibroblasts VITAL IN SECONDARY
contract wound and bring edges together and deposit collagen for scar healing.
Which is faster primary closure of secondary intention healing?
primary
What complication can you get in people with darker skin from wound healing
Keloid scars
What cell is only involved in secondary intention wound healing ?
Myofibroblasts - actin and myosin contract to pull wound edges together and deposit collage for scar formation
What are some wound management options in surgery “The reconstructive ladder” for stepwise wound management?
Secondary intention Primary closure Delayed primary closure Split thickness graft Full thickness skin graft Tissue expansion Random flap Pedicled flap Free flap
What are the two types of skin grafting available? and how do they differ?
Split-skin thickness skin graft (SSG) – does not contain the whole dermis
Full-thickness skin graft (FTSG) – contains the whole dermis (also transplanting hair follicles)
What is a skin graft ?
a surgical operation in which a piece of skin is transplanted to a new site on a patient’s body.
When are skin grafts necessary?
Skin grafts are necessary when the wound cannot be closed primarily and delayed healing is not appropriate.
A skin graft has no blood supply, and therefore depends on the vascularised bed where it is placed.
When is an example of a situation that might need a slit-skin thickness graft?
Split-skin grafting is often used for larger areas that require cover (for example in burns surgery) and they can be meshed to increase their size.
An example of a situation that might need a full thickness skin graft?
Full thickness grafts are used for smaller areas, e.g. face for a better cosmetic appearance.
Can only use areas with surplus skin e.g. supraclavicular fossa, pre/post auricular regions, groin, medial arm
