Flashcards in Wound Healing Complications Deck (23):
What are esmarch's principles of wound management?
Non-introduction of harmful things
Tissue rest - i.e. don't rush to close a wound
Avoidance of venous stasis
What is the most common cause of post-operative haemorrhage?
Failure of adequate haemostasis during surgery.
Coagulopathies may also cause this
How may a haematoma interfere with wound healing?
Physical separation of wound edges
Pressure on wound edges - necrosis and dehiscence
Prevention of free skin graft adherance
Physical barrier to capillary/leukocyte migration
Growth medium for bacteria
When would direct, surgical, management of bleeding be indicated?
Arterial bleeding that is severe/does not respond conservatively
Wound dehiscence due to pressure
Development of compartment syndrome
Secondary infection of haematoma
How can a haematoma be treated if it occurs?
Application of a warm compres 3x daily for 7 days.
What should be investigated in cases of:
a) Regional oedema
b) Generalised odeama
a) Veins, lymphatics and LNs surrounding the area for signs of occlusion etc.
b) Check hypoproteinaemia/cardiac disease?
How can oedema be managed?
Mild: May not require therapy
Moderate: Massage, hot/cold packing, physiotherapy
Care with bandaging as may compromise blood flow further
Remove sutures if occluding vessels
What is a seroma?
A collection of serum and tissue fluid that accumulates in a dead space between tissue planes of a wound.
How can seromas be treated?
Small - probably don't require treatment
- Corticosteroid injection
- Dead space management
What are the causes of wound dihiscence?
1. Excessive forces on the incision
2. Poor wound holding strength
When should inflammation/pyrexia resolve after surgery?
Within 48 hours.
What is the way to manage an infected wound?
If superficial then open wound management including, debridement, drainage and lavage is indicated.
Deeper wounds may require exploration and introduction of a drain.
When do delayed wound infections often occur?
When implants are used or if material is not properly cleaned from a site/is introduced to a surgical site e.g. hairs
What is a n eschar?
The dry leathery necrotised tissue structure.
What is wound contracture?
Loss of function of a body part, usually due to excessive scarring. Larger wounds left to heal by second intention are most at risk.
n.b. wounds comprising more than half the circumference of a limb are unlikely to heal by second intention
When might adhesions occur?
When the normal balance between fibrosis and fibrinolysis is disrupted.
What is a:
a) Blind ending tract that extends from and epithelial surface
b) Communicating tract extending from one epithelial surface to another
What is the treatment for a draining tract?
Identification and excision or,
Drainage and lavage then open wound management or closure with a drain
How can exposed bone be encouraged to heal?
Drill holes if periosteum not present
Trim to wound level if protruding over the wound edges as this is unlikely to heal
What common things will prevent wound healing?
Infection, necrotic tissue, foreign material, poor blood supply & unrecognised malignancy
What are the methods that promote granulation tissue formation generally aiming to do?
Improve blood supply
What are the most common factors preventing wound contracture?