34. Postoperative wound complications.

Wound Complications

Written by Rhiana Devadasan

34) Postoperative complications of wounds

Postoperative period = starts immediately after the operation & requires systemic, dynamic and intensive care monitoring & follow-up.

Postoperative wound complications:

1. WOUND PAIN

• 2-3 days
• depends on individual pain threshold
• due to cut nerves.
• Treatment: analgesics – methamisol, morphine.

2. HEMATOMA

• a localized collection of extravasated blood, in an organ, space, or tissue.
• There is a potential for secondary infection
• It may be caused by inadequate intraoperative hemostasis, Anticoagulants, Coagulopathy
• Treatment:
• Small haematomas = conservative Tx, wait for resorption
• Large haematomas = surgical evacuation

3. SEROMA

• a collection of liquified fat, serum and lymphatic fluid under the incision - yellow fluid.
• It can be caused by an extensive surgical dissection that disrupt lymphatic channels.
• It forms a localized well circumscribed swelling.
• Seromas often follow operations that involve elevation of skin flaps and transection of numerous lymphatic channels (eg, mastectomy, operations in the groin).
• Treatment: Drainage, Aspiration, Antibiotics (infection)

4. INFECTION (SSI)

• 3-5 days after operation
• Can be due to:
• Excessive trauma
• Contamination
• Tissue ischemia
• Saprophyte activation
• Low local immunity
• Low systemic immunity/HIV, cancer/
• Signs: edema, pain, redness, high temperature
• Treatment: drainage of pus, antibodies, removal of sutures/staples, debridement, antibiotics,leaving wound open to heal
• Due to severe wound infection, progressive postoperative wound gangrene may develop and cause necrotizing fasciitis.

5. WOUND DEHISCENCE

• Disruption or loss of continuity of a surgically closed layer of skin or fascia.
• It involves the separation of the abdominal musculoaponeurotic layers.
• 6-12 days
• due to hematoma, bad suture, infection, weak regeneration, cancer, anemia, hypoproteinemia, obesity, high intrabdominal pressure, chronic steroid use, etc
• Immediate operative closure is indicated
• Predisposing factors: Age >60years, conditions like diabetes mellitus, inadequate closure, intra-abdominal pressure and poor wound healing.

6. EVISCERATION

• outgoing intraabdominal organs
• Treatment: operative –Wound revision or Re-laparotomy

7. SCHLOFFER’S TUMOR

• a rare inflammatory pseudotumor.
• It usually appears [below peritoneum] several years after abdominal surgery or trauma.

8. BRAUN’S TUMOR

• above peritoneum with growth of connective tissue and granulation (granuloma type foreign body).

9. PAINFUL CICATRIX

• nerve ligation

10. OSSIFICATION

• (formation of or conversion into bone or a bony substance).