Dr alibakhshi general&cancer

surgeon

HEMATOMA AND SEROMA

Treatment — Small hematomas and seromas can be managed expectantly, while large collections should be drained. For symptomatic hematomas, the wound is opened partially or completely under sterile conditions. If there is no evidence of infection, the wound can be closed immediately. For suspected seroma, aspiration under sterile conditions may be all that is required.

Prevention Meticulous hemostasis during surgery is

essential. Procedures that are associated with a potential for collections of blood and serum in the subcutaneous tissues may benefit from prophylactic wound drainage, especially when large potential dead spaces are created (ie, repair of large ventral hernia, post-mastectomy). The prevention of fluid collection and subsequent infection is the primary aim. Obesity is a risk factor for local wound complications and drain placement may reduce complications but is controversial

Laparotomy closurePeritoneumFascia Technique Mass closureSubcutaneousSkin

Surgical site infection

Prophylaxis Prep Tissue damagePatient risk factors :diabetes,

obesity, immunosuppression, cardiovascular disease, smoking, cancer, previous surgery, malnutrition and prior irradiation

SURGICAL SITE INFECTION Treatment — Infected wounds are

opened, explored, drained, irrigated, debrided, and dressed open. If fascial disruption is suspected, drainage should be performed in the operating room. Once the infection has cleared and granulation tissue is apparent, the wound can be closed secondarily. The need for antibiotic therapy is determined by the extent of the infection, presence of systemic manifestations, and comorbidities of the patient 

Invasive wound infection

FASCIAL DEHISCENCE &Eviceration Burst abdomen

 Fascial disruption is due to abdominal wall tension overcoming tissue or suture strength, or knot security. It can occur early or late in the postoperative period, and involve a portion of the incision (ie, partial dehiscence) or the entire incision (ie, complete fascial dehiscence). 

Vac dressing

Laparostomy TechniquesBogota Bag

Vicryl mesh closure

SPECIAL SITUATIONSMorbid obesity Radiation