Complications in Wound Healing

H - haemosasis A - aseptic technique L - light touch (atraumatic) S - supply of blood preserved T - tension free closure E - even tissue apposition D - dead space obliterated

• no introduction of anything harmful • tissue rest • wound drainage • avoidance of venous stasis • cleanliness

> usually due to inadequate haemostasis at Sx - 1: slipped ligature - delayed 1: breakdown of ligature - 2* < LOOK THESE UP may be due to coagulopathy - pre-existing eg. vWF - 2* due to consumption of clotting factors and platelets in massive bleeds

• separates wound edges • pressure on wound edges -> necrosis and dehiscence • prevention of adherence of grafts and flaps • physical barrier to leucocyte migration • growth medium for bacteria • pain • organisation of haematoma may cause deformity (usually more cosmetic problem)

• light pressure bandage 12hrs • restrict movement (affected part or hole body - crate) • investigate coagulopathy if suspicious • supportive care (fluids +- blood prouducts)

• none (may spontaneously resolve) • aspirate + pressure • warm compress tid 7d

• normal accumulation of fluid in interstitial space but some wounds more prone to swelling than others • may potentiate dehiscence (^ hydrostatic pressure in intersitium reduces vascularity and delays healing) • DDx infection and cellulitits - local/regional/diffuse/dependant

• Massage • Support dressing • Removal of constricting sutures

• collection of serum and tissue fluid in dead space - one step after oedema

• tissue separation • skin flaps and grafts • tension on incision lines • interference with blood supply • WBC migration impaired`

• haematoma • oedema • abscess

> Usually resolve spontaneously - try to avoid causing this in the first place! conservative Tx includes - aspiration (though may introduce infection) - control of dead space with bandaging - control movement - drainage (active/passive) - removal of sutures allowing second intention healing surgical intervention possible but could end up with dehiscence and 2* infection

• inflame • lymphatic injury • poor haemostasis • traumatic Sx eg. dissection • implants - sutures and drains • movement • dead space

• 1* healing defect - 2* to surgical technique, judgement, wound bed or trauma

3-5d post surgery (unless self trauma)

• serosanginous discharge • swelling • necrosis, bruising, discharge

• 2* intention healing - surgical repair (though may end up in same position, find reason for initial dehiscence)

• sides of the wound uneven - often infected

• bacteria - presence and type [contamination does NOT always = infection] • local wound environment • local and systemic defence

• ischaemia (trauma, sx and postop, debridement) - inadequate debridement -> inflammation, delayed wound healing and ^ risk of infection

• stenosis eg. anus • functional incompetence • restriction of movement eg. joints • contracture -> loss of function

blind ending tract extending from one epithelial surface (epidermal or mucosal) deep site of infection, FB or sequestrum

communicating tract extending from one epithelial surface to another eg. oronasal, rectovaginal, brochooesophageal

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