Critically evaluate the measures which would promote healing and reduce complications in abdominal incisions for Gynecological surgery. Or critically assess the measures that can be taken to promote the best possible outcome related to abdominal incisions for gyneacological surgery
- Optimizing the patients pre-operative conditions
- Stop smoking
- Correct anemia and nutritional status
- Reduce weight
- Control medical conditions e.g. Diabetes mellitus
- Assess coagulation abnormalities in patient with anticoagulant therapy
- Reduce bacterial colonization – Avoid keeping the patient for a long duration in the ward before surgery , Skin shaving and cleaning just prior to surgery
- Intra- Operative measures
- Proper sterilization should be maintained during the surgery
- Site and extent of the incision which may be longitudinal, transverse or (Seldom) oblique, should be appropriate for the nature and purpose of the operation ( Avoid multiple incision – inverted T )
e.g.. midline incision is more likely to be complicated by the development of wound dehiscence and incisional hernia but allow adequate access.
- Prophylactic antibiotics for clean wounds and prolong antibiotics for contaminated wounds.
- Rigorous discipline in limiting wound contamination
- Proper haemostasis
- Wound drains in situation with large dead spaces and patient with prophylactic anticoagulation therapy
- Proper surgical technique
- Mass closure of longitudinal incisions reduces the risk of intestinal obstruction resulting from adhesions. Mass closure is recommended for patients with gynecological cancer and surgery after radiotherapy.
- Closure of peritoneal surfaces may increases the risk of intestinal obstruction from adhesions
- Non- absorbable sutures are associated with a lower risk of wound dehiscence than absorbable sutures
- Monofilament sutures are associated with lower risk of wound infection than polyfilament sutures.
- Apart from cosmetic appearances subcuticular stiches enhance post operative comfort ( Reduce the pain)
- Post operative measures
- If the dressing is blood stained, change immediately and inspect the wound. If not, dressing should not be removed for a period of 2-3 days.
- If the dressing is opened it should be done under sterile conditions.
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