What are some of the local complications post surgery?
1?
2?
3?
4?
5?
6?
7?
8?
1. Haemorrhage
2. Wound dehiscence
3. Wound infection
4. Scar formation
5. Neuropraxia
6. Delayed/non/mal-union
7. Return of original deformity
8. Iatrogenic deformity
What factors could result in Haemorrhage?
Poor 1?
Poor 2?
Ambulate patient 3?
4? therapy/thrombocytopaenia
Result
5?
6?
7?
1. haemostasis
2. suturing technique
3. too early
4. Anticoagulant
Result
5. Wound dehiscence
6. Infection
7. Scaring
Keloid scars
1? tumors
Composed mainly of an 2?
More common in 3?
Tx – 4?
1. Fibrotic
2. Overgrowth of either type III (early) or type I (late) collagen
3. Younger individuals and in highly pigmented individuals
4. Prevention, laser therapy
Hypertrophic scar formation
definition 1?
Poor 2?
• Excessive use of 3?
Wound dehiscence
Infection
•Poor scar management
post-suture removal
1. Raised scars that do not grow beyond the boundaries of the original wound
2. suturing technique
3. electrocautery
What are some signs of infection post-operatively?
Abnormal 1?
2?
Wound 3?
4?
1. post-op pain after 2-5 days
2. Dolor, oedema & erythema
3. dehiscence/discharge
4. Cellulitis - local extension of inflammation
How do you manage local infection?
Drainage of 1?
removal of 2?
Irrigation and wound dressing
MCS +/- FBC
1. wound
2. some or all sutures
What are the choices of antibiotics for local infections?
1?
(delayed allergy to penicillin) 2?
(immediate allergy to penicillin) 3?
1. Oral di/flucloxacillin 500 mg qid
2. Oral cephalexin 500 mg qid
3. Oral clindamycin 450mg tid
What are some complications following matrixecotomies?
1?
2?
3?
1. Hypergranulation tissue
2. Infection
3. Phenolburn
What are the general complications post surgery?
1. Extension of local infection
2. Pulmonary
3. Cardiovascular
4. Neurological
5. Gastroenterological
6. Gynaecological
Lymphangitis 1?
Lymphadenopathy 2?
Fever/chills
Management 3?
1. Superficial erythematous streaking to popliteal or inguinal glands
2. inflammation/ tenderness of inguinal lymph glands
3. Patient needs hospitalisation, ID consult and IV antibiotics
What do pts with COPD have?
1?
2?
3?
1. Asthma
2. Emphysema
3. Chronic bronitis
Atelectasis:
Collapse of the lung
Clinical presentation:
1?
2?
3?
4?
5?
1. +/- Elevated temp
2. Cough
3. Chest pain
4. Increased respiratory rate
5. Low O2 saturation
What are the treatment options for Atelectasis?
1. Deep breathing/spirometry
2. Fizziotherapy
3. Antibiotics
Atelectasis:
1? collapse
Decreased perfusion ⇒ 2?
Usually apparent 3?
Dx – x-ray – affected lobe is 4?
1. Pulmonary
2. absorption alveolar gas ⇒collapse with accumulation of secretions and mucous
3. post-op day 2
4. opaque
Pneumonia
Post-op chest
Characteristics 1?
2? of all operations
Predisposing factors 3?
Investigations 4?
Treatment 5?
1. Segmental atelectasis, hypoxaemia, elevated temp, purulent sputum
2. 5%
3. age, smoking, obesity, preexisting lung disease
4. chest x-ray, MC&S
5. fizziotherapy, antibiotics
What does the red arros show?
Unhealthy, white = congestion
Pulmonary Embolism
Blockage of 1? , usually originating as 2?
Up to 10% 3?
10% pts die 4?
1. pulmonary artery by embolis
2. DVT in pelvis or legs (90%)
3. post-op hospital deaths
4. within 1 hr with up to 20% dying subsequently
What are the sign/symptoms of pulmonary embolism?
1.Sudden pleuritic pain
2. tachypnoea
3. haemoptysis,
4. fever, anxiety, wheeze, cough.
What are the treatment options for pulmonary embolism?
1?
2?
3?
1. Medical emergency
2. Fibrinolytic drugs
3. Embolectomy
Deep vein thrombosis:
Present in 1? hospital deaths at autopsy
0.4% after childbirth
12-15% soft tissue injury to lower limbs
50% elderly after fracture femur/pelvis
2? all foot and ankle cases
1. 1. 25%
2. 0.25%
DVT
Common after 1? operations
Possible outcomes:
2?
3?
4?
1. lower abdominal, pelvic and lower extremity
2. Fibrosis of clot with formation of collateral circulation
3. Pulmonary emboli
4. Post DVT syndrome
What is the Virchow's triad for DVT?
1?
2?
3?
1. Hypercoagulation
2. Damage to vessel wall
3. Venous stasis
What are the minor risk factors for DVT/PE?
1?
2?
3?
4?
5?
6?
1. Immobility/bed rest
2. Increasing age
3. Minor surgery
4. Obesity
5. Varicose veins
6. Smoking
What are moderate risk factors for VTE?
1?
2?
3?
4?
5?
6?
7?
1. Malignancy
2. Heart or respiratory failure
3. Oestrogens (HRT or OCP)
4. Previous DVT/PE
5. Most non-major surgery
6. Thrombophilia
7. Postpartum period
What are major risk factors for VTE?
1?
2?
3?
4?
1. Major fractures (especially hip)
2. Hip or knee joint replacement
3. Other major surgery/trauma
4. Spinal cord injury
What's the management option for DVT prophylaxis?
Mechanical methods:
1?
reduce risk of DVT by 2?
3?
Pharmacological methods: 4?
1.Graduated compression stockings
2. ~50%
3. Intermittent pneumatic compression devices
4. Unfractionated heparin (UFH) and Low Molecular Weight Heparin (LMWH) both highly effective/ Aspirin: small but significant reduction in risk (375mg/day)
Heparin use:
For all high risk cases: 1?
Consider for moderate & lower risk cases as
well
1. LMW heparin
enoxaparin (Clexane) 20-40mg daily, or
daltepain (Fragmin) 2,500-5,000 units daily, or
Unfractionated heparin 5,000 units bd
1. The difference between Low molecular weight heparin and unfractioned Heparin?
2. Advantage of LMWH?
3. Advantage of UFH?
1. Little difference in terms of efficacy (DVT prevention) or safety (risk of bleeding)
2. Better dose-response relationship /More convenient (once daily)/ Less thrombocytopaenia/ Cost effective
3. Short acting and can be reversed with protamine
What are the contraindications to anticoagulant prophylaxis?
1?
2?
3?
4?
5?
1. Active bleeding
2. History of GI bleeding
3. High risk of bleeding (eg low platelet count)
4. Severe hepatic disease
5. Adverse reaction to heparin
What's the contraindications to mechanical prophylaxis?
1?
2?
3?
4?
1. Severe peripheral arterial disease
2. Recent skin graft
3. Severe peripheral neuropathy
4. Severe leg deformity
Podiatric Surgical management:
Aim to keep patient 1?
Austin better than 2?
Caution with 3?
Compressive bandaging rather than 4?
1. ambulating
2. CBWO
3. extended use of K-wires
4. B-K casts
What is Pseudo-membranous enterocolitis?
Uncommon fulminating bowel infection due to emergence of resistant strains of 1?
Sings and Symptoms 2?
Treatment 3?
1. Staphlococcus or Clostridium difficile
2. Severe diarrheoa/ Abdominal distention/ Hypotension/ Shock
3. Avoid prolonged antibiotic use Especially di/flucloxacillin/ Fluid replacement/ Vancomycin or metranidazole
