-
Superficial incision SSI heals in _________, is located in the __(2)__, and has clinical aspects of... (5)
30 days; skin or subQ tissues; pus, redness, pain, swelling, heat
-
Deep incisional SSI heals in _________, is located in the __(2)__, and has clinical aspects of... (5)
within 30 days (or 1 year if implant was used); fascia or muscle; pus, abscess, fever, pain, swelling
-
Organ/ space SSI heals in _________, is located in the __(2)__, and has clinical aspects of... (4)
within 30 days (or 1 year if implant was used); organ or body cavity; pus within space or organ, faver, pain
-
What are infection risk factors? (5)
- Patient: endocrinopathy, pyoderma, obesity
- Procedure: wound classification
- Pre-operative: hair removal, peri-operative antibiotics
- Surgical: aseptic technique, environment, duration of sx, implants used
- Post-op: incisional care, environment
-
How do we avoid superficial incisional SSI? (3)
- pre-operative planning/ review risk factors
- monitoring post-op (catch early)
- e-collar (prevent licking)
-
What are treatment options to treat skin infection?
- empirical for gram +: cephalexin, clavamox (culture and sensitivity recommended)
- +/- open wound management (open, debride, bandage, depending on extent)
-
How can we avoid deep incisional SSI? (2)
- re-op planning/ review risk factors
- monitoring
-
What are treatment options for body wall infections/ deep incisional SSI? (3)
- antibiotic therapy: empirical or C&S
- open incision if not already open (always!)
- open wound management
-
What are risk factors for dehiscence? (7)
- technical/ surgeon error *****
- patient factors (endocrinopathy, anemia, hypoproteinemia)
- tension
- infection
- neoplasia
- self-mutilation
- post-op care (owner compliance)
-
What technical errors can lead to SS dehiscence? (3)
- improper suture placement- missed holding layer
- suture- wrong type, too far apart, poor knot ties, poor tissue apposition, mishandling suture material
- tension- tying suture too tightly, lose blood to wound edges
-
What is the holding layer of the body wall?
external rectus fascia
-
What is the holding layer of the GI or bladder?
submucosa
-
Patient factors that may contribute to dehiscence of the GI tract or bladder post-op? (3)
hypoproteinemia, infection, neoplasia
-
What can lead to post-op septic peritonitis? (6)
- dehiscence
- contamination during sx
- rupture or perf
- ascending infection
- migrating foreign objects
- retained sponges
-
How do septic peritonitis patients present? (5)
- abdominal pain
- distention
- shock
- vomiting
- fever
-
What are risk factors for post-op SS seroma? (4)
- dead space
- inflammation (foreign materials, irritants, trauma/ too much surgical manipulation)
- high activity post-op
- high motion area
-
How do you avoid seroma formation? (6)
- gentle tissue handling
- minimize dead space/ place a drain
- bandaging
- minimize inflammation
- post-operative care
- surgical planning
-
How do you treat a seroma? (5)
warm compresses, bandaging, exercise restriction, E- collar, drain (only in refractory cases)
-
What are risk factors for intra-op (4) and post-op (4) hemorrhage?
- intro-op: technique, coag defects, specific procedures/ sx locations, specific diseases
- post-op: technique, missed intra-op bleed, changes in BP, coag defects
-
Scrotal hematoma and hemoabdomen are usually due to...
ligature faillure
-
How do you avoid hemorrhage? (4)
hemostasis techniques, hemostatic agents, pre-op planning, careful patient assessment (coagulopathies, etc)
-
What are treatment options for hematoma? (3)
bandaging, supportive care, +/- sx
-
What are risk factors for ileus? (7)
- intestinal surgery
- peritonitis
- pancreatitis
- hypokalemia
- long intra-abdominal surgery
- intestinal obstruction
- drugs
-
How does ileus present clinically? (5)
inappetance, pain, vomiting, regurg, lack of gut sounds
-
How can you treat ileus? (6)
correct underlying problem, fluid therapy, NPO, prokinetics, discontinue medications, ambulation/ walks
-
Risk factors for stricture? (2)
ischemia, poor technique
-
How do you avoid stricture? (4)
- gentle tissue handling
- suture selection
- tissue approximation
- proper closure techniques
-
When do you do an abdominal exploratory for a suspect ovarian remnant?
during estrus- easier to find
|
|
