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VETM 411: Basic Surgical Principles > wound complications - Emily > Flashcards

wound complications - Emily Flashcards

1
Q

What affects wound healing?

A

-Wound factors
-Host factors
-External factors

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2
Q

What is the most significant complication to wound healing?

A

Bacterial infection

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3
Q

What are two ways bacteria can invade a surgical site?

A
  1. Local route (patient surfaces, instruments, surgeon, environment)
  2. Distant route (other site infection in patient, hematogenous spread)
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4
Q

What is the approximate risk of SSI in a clean wound?

A

1-5%

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5
Q

What is the approximate risk of SSI in a clean contaminated wound?

A

5-10%

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6
Q

What is the approximate risk of SSI in a contaminated wound?

A

10-30%

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7
Q

What is the approximate risk of SSI in a dirty wound?

A

> 30%

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8
Q

Which tissue types are involved in superficial SSI?

A

Skin and subcutaneous

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9
Q

Which tissue types are involved in deep incisional SSI?

A

Muscle and fascia

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10
Q

Which tissue types are involved in organ or space SSI?

A

Peritoneum, pleural space, etc

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11
Q

What is the infectious dose of bacteria?

A

> 10^5 bacteria/gram of tissue

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12
Q

What bacterial factors can affect the infectious dose needed?

A

-High microbe virulence (adherence, antibiotic resistance, biofilms)
-Foreign material in wound or site
-Host site dependent (oral mucosa and tissues or mouth vs synovial fluid or CSF)

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13
Q

What are important surgical risk factors?

A

-Duration of surgery (TIME)
-Aseptic technique
-Foreign material
-Surgical technique
-Emergency procedures

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14
Q

What are Halstead’s principles of surgery?

A

-Gentle tissue handling
-Hemostasis
-Preservation of blood supply
-Strict aseptic technique
-Minimize tension
-Accurate apposition of tissue
-Eliminate dead space

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15
Q

What are common symptoms of SSI?

A

-Fever, redness, swelling, pain
-Purulent discharge
-Wound dehiscence/delayed healing
-Usually within 30 days

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16
Q

What are some ways to prevent SSI?

A

-Careful skin prep
-Minimize trauma (ex. scalpel vs laser)
-Minimize trash
-Minimize surgical time
-Peri-operative antibiotics if indicated

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17
Q

What is prophylactic antibiotic use?

A

Given pre-operatively and possibly intra-op to prevent establishment of infection

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18
Q

What is therapeutic antibiotic use?

A

Used post-operatively when indicated to treat an established infection

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19
Q

When would it be a good idea to give prophylactic antibiotics?

A

-Fracture repair with implants
-Abdominal surgery
-“field” surgery
-Anything other than clean surgeries

20
Q

What are the principles of administration of surgical antibiotics?

A

-Bactericidal (1 dose given 30 mins before surgery)
-Maintain levels throughout surgery (2nd dose if surgery is >3 hours or 1-2x 1/2 life of drug)
-Not necessarily needed >24hrs post op

21
Q

What are routes of administration for antibiotics?

A

-Systemics (IM or IV)
-Regional (perfusion with tourniquet, antibiotic implants)
-Topical (tissue irrigation)

22
Q

What are some procedures where prophylactic antibiotics would be a good idea?

A

-Long surgeries (>90mins)
-Prosthetic (permanent) implants
-Patients with prostheses undergoing surgery
-Severely infected or traumatized wounds
-Orthopedic surgeries
-Respiratory surgeries
-GI surgeries
-Urogenital surgeries
-Systemically compromised patients

23
Q

What is dehiscence?

A

A complication of wound healing in which the wound ruptures along a previously closed surgical incision

24
Q

What are some wound factors that can lead to dehiscence?

A

-Infection
-Excessive tension
-Seroma/hematoma formation (dead space)
-Non-viable tissue or poor perfusion
-Saliva or synovial fluid in wound
-Foreign body
-Neoplasia

25
Q

What are some patient factors than can lead to dehiscence?

A

-Systemic disease
-Nutrition
-Medications
-Neoplasia

26
Q

What are some environment factors than can lead to dehiscence?

A

-Post op wound trauma
-Movement

27
Q

What are some signs of impending wound dehiscence?

A

-Discharge along suture line
-Excessive swelling or fluid accumulation under skin
-Evidence of suture failure
-Evidence of tissue necrosis

28
Q

How many days post-op is dehiscence likely to happen?

A

7 days

29
Q

How can you prevent wound dehiscence?

A

-Prevent contamination
-Minimize tension
-Immobilize joints to minimize movement
-Reduce dead space
-Reduce swelling
-Protect from trauma
-Overall patient care (meds, nutrition)

30
Q

What are some things you would do to work up a wound that isn’t healing well?

A

-Impression smears and culture
-Biopsy and culture
-Radiographs
-Wound exploration

31
Q

What are some factors that contribute to delayed wound healing?

A

-Foreign body
-Reduced local blood flow
-Systemic factors (diseases)
-Drugs (corticosteroids, chemotherapy, etc)

32
Q

What is a bone sequestrum and which species is it most common in?

A

A piece of dead bone in the wound. Most common in horses

33
Q

What causes a bone sequestrum?

A

-Loss of blood supply in periosteum
-Bacteria invade and colonize dead bone

34
Q

Why does a bone sequestrum impair healing?

A

It acts as a foreign body and provides a place for bacteria to thrive

35
Q

What are some signs that a bone sequestrum might be present?

A

-Persistent soft tissue swelling
-More pain than expected with palpation
-Mild lameness
-Persistent cleft in granulation tissue
-Persistent drainage
-Wound won’t heal

36
Q

When is a bone sequestrum likely to occur?

A

3-4 weeks after initial injury

37
Q

What are 3 types of excessive wound healing?

A

-Fibroproliferative wound healing
-Contracture
-Adhesions

38
Q

What is fibroproliferative wound healing?

A

-Exuberant granulation tissue (proud flesh) - OPEN
-Hypertrophic scar/keloid - CLOSED

39
Q

What type of wounds are at high risk of excessive wound contracture?

A

-Large wounds
-Wounds in high motion areas
-Wounds left to heal by second intention

40
Q

What can excessive wound contracture lead to?

A

Impaired function, pain and disability

41
Q

What are some ways to treat/prevent excessive wound contracture?

A

-Primary closure or delayed primary closure when possible
-Reconstructive techniques
-Physiotherapy
-Scar revision procedures as treatment

42
Q

What is tissue adhesion?

A

Scar formation and contracture affects internal organs or tissue in a pathologic manner

43
Q

How can the risk of tissue adhesion be reduced?

A

-Good surgical technique and tissue handling
-Anti-adhesion products for intraoperative use
-Physiotherapy

44
Q

What is exuberant granulation tissue?

A

Excessive and prolonged proliferative phase where granulation tissue extends above epithelial margins

45
Q

What are consequences of granulation tissue above epithelial margins?

A

-Inhibits epithelialization and contraction
-May cause expansion or enlargement of wound

46
Q

What are treatment options for excessive granulation tissue?

A

-Surgical excision
-Local anti-inflammatories
-Reduce inflammatory stimuli
-Possibly a bandage
-Skin grafting

47
Q

What are the 4 main wound healing complications?

A

-Infection, SSI
-Delayed wound healing (dehiscence)
-Bone sequestrum
-Excessive wound healing

VETM 411: Basic Surgical Principles (10 decks)

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