Complications in the surgical wound

Wound infection
By administering ATB after surgery, we can suppress these symptoms, we will check the result of the treatment only after dressing.
 * Sources of infection during surgery:
 * operated infected tissue – drainage of abscess, purulent peritonitis, etc.; causes very common secondary wound infections;
 * source in the patient – ​​skin, open alimentary canal;
 * contamination of the wound during surgery – by the operating group (hands, droplets) or material;
 * from the environment of the room - by air.
 * Sources in the postoperative period:
 * unsterile bandaging – often caused by nosocomial strains;
 * good conditions for bacteria - contusion, necrotic tissue, hematoma.
 * Manifestations of infection in the surgical wound:
 * the inflammation is usually in the subcutaneous tissue;
 * wound infection – manifested on the 5th - 6th day after surgery by fever, leukocytosis;

Prevention – compliance with the rules of asepsis and physiological operation;

Treatment
 * removal of stitches along the entire length of the wound, opening of the wound and evacuation of pus;
 * we leave the wound open under a bandage, or insert a drain into it;
 * we can apply anti-inflammatory or disinfectants (Višněvski, Rivanol, etc.);
 * we take a sample for cultivation.

Bleeding from the surgical wound
Clinical picture  – blood either flows out from the wound or accumulates under the skin and a hematoma forms.
 * The most common causes of bleeding from a surgical wound
 * coagulation disorders;
 * the consequence of inadequate control of bleeding during surgery;
 * slippage of the ligature;
 * disruption of the vascular wall by infections.
 * Prevention
 * careful operation, adjustment of coagulation;
 * in operations where bleeding can be expected (breast ablation, larger hernia operations), we place Redon drain under the skin.
 * Treatment
 * we can try to stop a slight leakage after the operation with compression (a bandage or sandbag);
 * arterial bleeding usually requires revision of the wound and stopping the bleeding with a ligature or with a prick by needle;
 * a smaller hematoma can be absorbed, a larger one must be drained.

Dehiscence of the wound
Dehiscence occurs mainly in laparotomy wounds; patients have an increased risk with malignancy, cachexia, protein and vitamin C deficiency, patients obese, icteric. Triggering moment – ​​cough, vomiting, meteorism, getting out of bed, …;
 * Causes:
 * characteristics of the organism (malignancy, immunodeficiency, malnutrition, …);
 * technical error during suturing (wrong incision guidance, drains in the wound);
 * wound infection, bleeding;
 * drugs – cytostatics and corticosteroids.

There can be a gap in the entire width with a protrusion of organs or just an opening in some layer:
 * dehiscence of the skin and subcutaneous tissue - during premature removal of stitches, during infection and bleeding;
 * in case of unrecognized gap of the fascia → hernia in the scar.
 * Prevention:
 * elimination of causes already before surgery (if possible);
 * postoperatively – suppression of cough, prevention of vomiting (probe), teaching the patient to hold his stomach when coughing.
 * Treatment:
 * skin dehiscence - resuture, cure of infection, …;
 * dehiscence of the entire wound - resuture always necessary.

Wound necrosis
Causes – the skin is stripped of the subcutaneous tissue, sutured under great tension;

Clinical picture – purple coloring of the edges, later they turn black;

Treatment – loosening of sutures, excision of necrotic tissue.

Inflammation of the skin and around the wound
Causes – disinfection, plaster, discharge of secretions from the wound (mainly with stoma);

Prevention Treatment – removing the cause, washing with chamomile solutions, oil, glycerine, liquid powders, …
 * before the operation, we ask about allergies to disinfectants, plasters;
 * we try to remove secretions actively (drainage);
 * we lubricate the skin around the drains with protective agents;