Wound dehiscence Flashcards
1
Q
What is WD?
A
- wound fails to heal, often re-opening a few days after surgery (most common in abdominal surgery)
2
Q
What are the 2 types of WD?
A
Superficial dehiscence
- skin wound alone fails, with the rectus sheath remaining intact
Full thickness dehiscence
- rectus sheath fails to heal and bursts, with protrusion of abdominal content (often termed a “burst abdomen”)
3
Q
What is the cmost common cause of WD?
A
- Infection
4
Q
What are the RF of WD?
*patient factors, intraoperative factors, post op factors
A
Patient factors
- age, male, DM, steroids, smoking, obesity, malnutirion
INtra op factors
- Emergency surg, abdo surg, >6hrs surg, wound infection, poor surg technique
Post op factors
- Prolonged ventilation, post op blood transfusion, poor tissue perfusion, excessive pt coughing, radiotherapy
5
Q
What are the cf of WD?
A
- 5-7 days post op
- visible open wound
- healing poorly
- full thickness
- bulging of the wound and seepage of pink serous or blood-stained fluid
- wound discharge
6
Q
What are the Ix of WD?
A
- clinically diagnosed
- wound swabs- culture
7
Q
How would you mx WD?
A
Superficial
- wash with saline
- simple wound care (e.g. packing the wound with absorbent ribbon gauze)
- Vacuum-Assisted Closure - for more extensive wounds
Deep
- analgesia
- start broad spectrum intravenous antibiotics
- Cover the wound in saline-soaked gauze
- arrange urgent return to theatre for re-closure of the wound
- large interrupted suture / vacuum dressing
8
Q
How would you prevent WD?
A
- Optimisation of co-morbidities
- tx surgical site infections
- Avoiding heavy lifting
- encouraging adequate post-operative nutrition
