[외과]Surgical Complications 외과적 합병증

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Wound Complication

1. wound dehiscence
1) Etiology
dehiscence : 술후 early 시기의 fascial layer의 separation
cf. evisceration: large or complete dehiscence로 wound를 통해 viscera가 튀어나옴.
★ contributory factors in wound dehiscence
improper/inadequate surgical closure technique
increased stress/pressure/tension on closure
bowel distention(due to gas or edema)
ascitis (hepatic or pancratic )
coughing, vomiting, straining
massive obesity
advanced age
impaired tissue integrity
malnutrition and immune deficiency
coexisting diseases
D.M.
chronic renal insufficiency
malnutrition
drug exposure
wound events
2) Presentation
① partial dehiscence
② fascial disruption
③ serosanguineous drainage
3) Prevention
proper closure technique (fascial retention suture)
dehiscence risk가 높은 환자는 fascial edge open하여 skin level만 closure하거나
water tight coverage - 이후 condition 회복시 fascial closure

2. Hematoma

1) Etiology
abnormal collection of blood in the subcutaneous layer of a recent incision.
seroma보다 worrisome, potential for secondary infection
① heparin & aspirin을 투여받은 화자
② 수술중 hypotension
③ coagulation disoder pt
wound hematoma는 wound infection을 야기할 수 있음

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