Wounds Flashcards
Wound infection
5-7d post-op
Organisms: Staph. aureus and Coliforms
Wound infection classification
- Clean: incise uninfected skin w/o opening viscus
- Clean/Cont: intra-op breach of viscus (not colon)
- Contaminated: breach of viscus + spillage or opening of colon
- Dirty: site already contaminated – faeces, pus, trauma
Pre-operative risk Factors for wound infection
- ↑ Age
- Comorbidities e.g. DM
- Pre-existing infection e.g. appendix perforation
- Pt. colonisation e.g. MRSA
Operative risk factors for wound infection
- Op classification and wound infection risk
- Duration
- Pre-op Abx, asepsis technique
Post-operative risk factors for wound infection
- Contamination of wound from staff
Presentation of wound dehiscence
Occurs approx 10days post-op
• Preceded by discharge from wound
Pre-Operative Factors for wound dehiscence
- ↑ age
- Smoking
- Obesity, malnutrition, cachexia
- Comorbdities e.g. DM, uraemia, chronic cough, Ca
- Drugs - steroids, chemo, radio
Operative Factors for wound dehiscence
- Length and orientation of incision
- Closure technique
- Suture material
Post-operative Factors for wound dehiscence
- Increased intra - abdominal pressure - e.g. prolonged ileus causing distension
- Infection
- Haematoma / seroma formation
Jenkin’s Rule
6:1 - suture length: wound length as the optimal ratio in abdominal closure
Mx of full wound dehiscence
- Swabs
- Replace abdominal contents and cover with sterile soaked gauze
- IV Abx: cef+met
- Opioid analgesia
- Call senior and arrange theatre
- Repair in theatre
- Wash bowel
- Debride wound edges
- Close with deep non-absorbable sutures (e.g. nylon)
• May require VAC dressing or grafting
Mx of superficial dehiscence
Open wound and examine the sheath to ensure it has not dehisced
Washing out the wound with saline and simple wound care
Will heal by secondary intention - takes several weeks
Clinical features of wound infections
Spreading erythema Localised pain Pus or discharge from the wound Wound dehiscence Persistent pyrexia
Investigations of wound infections
Wound swabs - culture
Blood test
Mx of wound infections
Any sutures or clips removed, -drainage of pus and wound packing if required.
Empirical antibiotic
Monitor for sepsis
Pre-Operative prevention of wound infections
Prophylactic abx if indicated - prosthesis, clean-contaminated surgery, or contaminated surgery
Do not remove hair routinely
Patient advice:
- shower prior to surgery
- weight loss
- optimised nutrition
- good diabetic control
- smoking cessation
Keloids
Abnormal proliferation of scar tissue and projects beyond original wound margins
- does not regress
Risk factors for keloid scars
Ethnicity – Black and Asian populations
Age –20-30yrs
Cause of injury – burns
Anatomical site – commonly occur in scars on the ear lobe, shoulders, and sternal notch
Previous keloid formation
Pathophysiology of keloid scars
Excess fibroblast activity
Mx of keloid scars
Intralesional steroids
Silicone gel
Radiation therapy
