L Care and monitoring of post-operative wounds

The injury is accompanied by dissection of the skin and muscle tissue. To prevent bleeding and normal healing, it is necessary to align the edges of the affected area as much as possible. The technique is used for surgical interventions. A sutured wound is an object of close care, due to the lack of sterility during healing.

Features of caring for a sutured wound

At the initial stages, in case of extensive injuries or complex surgical treatment, treatment and dressing are carried out by a nurse in a hospital. The surgeon who performed the procedure should tell you about the rules for caring for a sutured surgical wound.

Necessary tools and materials for treating a sutured wound:

• Smooth surface. At home, you can use a coffee table or trestle bed. First, it is washed with warm water, then wiped with disinfectants.
• Clean towels for tools.
• Gloves, bandages or gauze swabs, cotton wool.
• Scissors.
• Medical tweezers.
• Antiseptic drugs.
• Hydrogen peroxide.
• Medicines as needed.

The principle of such processing is the obligatory observance of asepsis.

Features of wound care in the postoperative period:

• To reduce the intensity of pain, the use of painkillers as prescribed by a doctor is indicated.
• Treat 2-3 times a day with antiseptics. In hospitals, Diamond Green solution is used. Manipulations are carried out daily until the surface is completely healed.
• It is strictly prohibited to wet a stitched wound. You cannot sprinkle with antiseptics or antibiotics in powder form. Do not use healing ointments.
• Patients with diabetes need to monitor their blood glucose levels. The rate of restoration of the skin surface in such patients is lower.

After healing, no additional care is required.

16.2.2, Observation of respiratory system functions

In the first hours after surgery, ventilation of the lungs is impaired (pain in the wound, shallow breathing). Mucus can accumulate in the lungs, which leads to cessation of ventilation in the corresponding parts of the lungs, atelectasis, and subsequently to pneumonia. A serious complication is asphyxia, which occurs when the tongue retracts and the airways are blocked by vomit.

When the tongue retracts, bubbling breathing, snoring appear, and the patient turns blue. In such cases, you should quickly move the patient’s lower jaw forward and insert an air duct into the oral cavity.

To prevent asphyxia, which occurs when vomit enters the airways, the head must be turned to the side in advance, and after vomiting, the patient should be asked to rinse his mouth with water. When vomit enters the respiratory tract, a severe cough, bluishness of the skin and mucous membranes, and bubbling breathing appear. During an urgently performed bronchoscopy, the trachea and bronchi are released by suctioning out vomit and mucus, the bronchi are washed with saline, and antibiotics are administered. In the following days, antibiotics are administered parenterally (prevention of pneumonia).

To thin sputum, patients (especially smokers, with chronic diseases of the lungs and bronchi) are prescribed expectorants, inhalations with soda and bronchi dilators (aminophylline, etc.). In the first 2-3 days after surgery, painkillers are used to reduce pain during expectoration; the effect is observed 20-30 minutes after the injection, while the patient coughs to reduce pain in the wound by holding it with his hands. Patients must be taught proper coughing and deep breathing (breathing exercises) in the preoperative period. Patients should take 20-25 deep breaths and exhalations several times a day, inflate rubber balloons, bladders, etc. Therapeutic exercises, if the condition allows, should begin from the first day after surgery, especially for bronchopulmonary diseases. Improvement of pulmonary ventilation is facilitated by early activation of patients after surgery (early getting up, walking, therapeutic exercises). To prevent congestive pneumonia, the patient should not walk in bed in a semi-sitting position at an angle of 30-35°, often turn to the left and right side; Chest massage, mustard plasters, cupping are useful.

After the patient is allowed to walk independently, there is no need to use preventative medications; the patient, under the guidance of a physical therapy instructor, should do breathing exercises daily.

Means for treating the surface of a sutured wound

The treatment consists of 2 stages - cleaning the skin adjacent to the scar. The epidermis is cleaned with a soap solution and hydrogen peroxide. It is necessary to avoid contact with liquid on the damaged area. After these manipulations, a sterile bandage is applied.

Do not touch or pull the threads that tighten the seams and knots. There is a risk of injury and divergence of the skin edges.

Antiseptic agents for treating a sutured wound:

• Hypertonic salt solution (or sodium chloride) with a concentration of 10%. For external use only. The drug has a detoxifying, disinfecting, drying effect. There are no contraindications.
• Potassium permanganate solution (potassium permanganate). The crystals need to be dissolved in boiled water. The color of the liquid should be pale pink. The drug has an antiseptic, drying effect. Avoid contact with eyes, do not use high concentrations, as this may cause burns and a low rate of tissue regeneration.
• Hydrogen peroxide. The drug softens and removes remaining pus and blood. Does not have a bactericidal effect. Apply using a gauze pad. Blasting is allowed. After the release of oxygen ceases, the wound should be dried with a cotton swab.
• Brilliant green (zelenka) has an antibacterial and fungicidal effect. Does not irritate the epidermis, but does not relieve inflammation. The product is applied to a previously cleaned seam using a cotton swab. The drug is incompatible with iodine and alkaline solutions. It may sting for some time after application.
• Chlorhexidine is a ready-made solution for external treatment of tissues. Has an antibacterial effect, is not active against fungal flora. Apply in a stream. The medicine is incompatible with soap and alkaline solutions.
• Miramistin is a ready-made solution. Active against pathogenic and fungal flora. Apply using a cotton swab or jet.
• Betadine (povidone-iodine based). Acts on bacteria, fungi, viruses and protozoan microorganisms. Apply to the seam using a cotton swab. The product should not be used for diseases of the thyroid gland, imbalance of thyroid hormones and in early childhood.

There is a wide selection of antiseptics on the shelves of pharmacies, from expensive to budget ones. You should buy the drug recommended by the doctor, based on the patient’s condition and medical history.

16.2.3. Monitoring the functions of the cardiovascular system

The state of the cardiovascular system is monitored during surgery, after transferring the patient from the operating table and during transportation to the surgical department or intensive care unit. After the operation, under general anesthesia, control is carried out by an anesthesiologist (skin and mucous membrane color, blood pressure, pulse). If infusion of solutions continues during transportation of the patient, it is necessary to control the position of the needle in the vein or catheter, and ensure that air does not enter the vein from the infusion system. The most common complication during these minutes is acute cardiovascular failure, in which pallor of the skin and mucous membranes quickly develops, cyanosis of the lips, cold sweat, increased pulse (weak filling and tension, sometimes thread-like), breathing, and decreased blood pressure are observed. In such cases, it is necessary to establish the cause of cardiovascular failure and, first of all, to exclude bleeding from the surgical area (slipping of a ligature from a vessel, pushing out a blood clot). External bleeding is easily diagnosed, internal bleeding is much more difficult (in the abdominal, chest cavity, stomach, etc.); The threat of bleeding is especially high in diseases caused by impaired hemocoagulation processes (obstructive jaundice, sepsis, thrombocytopenia, etc.). Treatment depends on the source and intensity of the bleeding. For bleeding from small vessels, cold, tamponade, a pressure bandage are applied locally, and drugs that increase blood clotting (fibrinogen, film, thrombin, Vicasol, etc.) are administered.

In the postoperative period, complications such as myocardial infarction, thrombosis and thromboembolism are observed in patients with hypertension, diabetes mellitus, who have previously had a myocardial infarction, with obesity, in old and senile age.

Myocardial infarction is characterized by pain in the heart or behind the sternum radiating to the left scapula. A heart attack may proceed atypically (pain is localized in the epigastric region); in diabetes mellitus, a painless form of myocardial infarction occurs in 30-50% of cases. In all cases of the disease, symptoms of acute cardiovascular failure are observed, expressed to varying degrees.

A frequent complication of the postoperative period is thrombosis and thromboembolism, which are caused by blood clots, most often formed in the deep veins of the lower extremities, as well as at the site of venipuncture or prolonged standing of venous catheters.

In the lower extremities, thrombus formation occurs in the venous sinuses of the calf muscles and deep veins of the legs during surgery or in the first days after it. Deep vein thrombosis is characterized by pain in the calf muscles, slight swelling of the foot, pain in the calf muscles on palpation and in the projection of the vascular bundle. The so-called floating (floating) blood clots are especially dangerous, as they can break off even with slight physical exertion or coughing.

When they break off, blood clots travel through the bloodstream into the pulmonary arteries, causing thromboembolism. When a large thrombus occurs, the trunk of the pulmonary artery becomes blocked and instant death occurs. Blockage of its smaller branches is manifested by sharp chest pain, shortness of breath, bluishness of the skin of the face, neck and upper half of the chest. Thrombosis is most often observed in varicose veins, deep vein thrombophlebitis (post-thrombo-phlebmtic syndrome), after long-term traumatic operations, in cancer patients, in old age, in obesity, in dehydrated patients, as well as during prolonged stays in bed.

Prevention of thrombosis consists of bandaging the lower extremities with elastic bandages before and after surgery, early physical activity in bed and early getting up and walking, prescribing anticoagulants (anticoagulants) direct (heparin, fraxiparin) and indirect (pelentan, neodicumarin, warfarin, etc. .) actions. It is necessary to systematically monitor the parameters of blood coagulation and anticoagulation systems.

Possible complications and what to do about it

Complications that may occur:

• Serroma is the formation of exudate in the cavity. The wound cavity will not heal. With secondary infection, suppuration begins.
• A hematoma develops when measures to stop bleeding are ineffective. The blood compresses the tissues, causing their necrosis. It is an ideal environment for the propagation of pathogenic flora. The wound, sewn up long ago, begins to fester.
• Necrosis occurs due to irregularities in suturing. The tissues do not receive nutrients, swell and die. Excision is indicated due to the risk of sepsis.
• An abscess is the formation of phlegmon that appears when a secondary infection occurs. Often pathologies are a consequence of the patient’s reluctance to go to the emergency room in a timely manner.
• The divergence of the edges occurs due to carelessness after removing the seams. Treatment is only surgical.
• Malignization occurs with a long-term inflammatory process and lack of epithelization in a timely manner.

All conditions are accompanied by pain, swelling and hyperemia of nearby tissues. When sepsis occurs, the temperature rises to pyretic values, a decrease in pressure, and dehydration are observed. If such symptoms appear, you should immediately contact a medical facility. The surgeon will have to re-treat the sutured wound and prescribe antibiotic therapy.

Suture care after surgery

When recovering from surgery, the last thing you want is problems with the stitch. With proper care, the suture turns into a scar, but for this, such care must begin immediately upon returning home.

When recovering from surgery, the last thing you want is problems with the stitch. A suture is an incision or wound necessary to perform an operation. At the end of the surgical intervention, the doctor sews up the suture or secures its edges with paper clips, tape or special glue. With proper care, the suture turns into a scar, but for this, such care must begin immediately upon returning home. Please note that the incisions vary significantly in size and location.

How to stay healthy?

After the operation, the doctor will tell you in detail how to care for the suture. In particular, he will advise the following:

• When to remove the bandage. In some cases, the bandage is removed the day after surgery. This depends primarily on the location of the incision and the complexity of the operation. The vast majority of stitches do not require dressing after a few days. However, in some cases, wearing it is advisable to protect a vulnerable seam.
• Keep the seam dry. This is especially important in the first 24 hours. Avoid showering and bathing. Try to simply wipe yourself with a damp washcloth. Washing with soap and water is usually acceptable the next day. Give preference to showering when the seam is open or if it is sealed with adhesive tape. After washing, gently blot the seam, avoiding rubbing.
• When should stitches be removed? This procedure is performed by a doctor. It is forbidden to remove stitches yourself. However, you will have to return to the doctor for this purpose only if the suture material used does not dissolve on its own. Usually, depending on the operation, the sutures are removed 3-20 days after the intervention. It also depends on the location of the suture and the speed of wound healing. After removing the stitches, the doctor may cover the wound with a special plaster that provides additional protection to the wound. This patch can be removed after 3-7 days. In some cases, the incision is secured with internal sutures (located under the surface of the skin), which gradually dissolve into the body and do not require removal. Healing skin needs several months to fully regain its strength.
• Limit movement around seams. If you can limit the tension on the skin around the incision, this will greatly speed up and facilitate healing. Avoid actions that expose the seam to unraveling. Specifically, your doctor will ask you to avoid heavy lifting, excessive muscle strain, physical activity, and sports for at least a month after surgery. If the stitch comes apart, contact your doctor immediately.
• Always wash your hands before any contact with the stitch. Ask your doctor if you need to use soap or wipes containing rubbing alcohol on the wound.

Recommendations

• If you notice that the wound has opened, call your doctor immediately. He may decide that it is not advisable to re-attach it with sutures. In this case, he will tell you in detail and show you how to care for her. Most likely, we will talk about applying bandages that absorb discharge from the incision. However, such dressings will need to be changed regularly. Over time, the wound will heal, starting from the inside.
• If the incision site is very red, this may be a sign of infection. In this case, a certain degree of redness is the absolute norm. If the color becomes deeper and deeper, or if the red halo extends more than 1 cm from the wound, consult a doctor. The same actions are required by the appearance of pus and increased sensitivity or pain of the wound. The doctor may prescribe an ointment containing antibiotics to be applied to the wound, which can be purchased at any pharmacy.
• If the incision bleeds, change the dressing. Apply pressure to the suture site for a few minutes to stop the bleeding. If this fails, contact your doctor.
• When in the sun, cover the incision with a bandage or clothing for the first 6 months after surgery. The fact is that when burned, the scar will darken and will be much more noticeable in the future.

Questions to ask your doctor

• Could the incision become inflamed while I am still in the hospital?
• How to prevent clothing from irritating a wound?
• Is the suture removal procedure painful?

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Healing time

Healing of a sutured wound goes through 4 stages. The speed of each person depends on the location of the injured area - thigh, chin, lower leg, eyebrow, other parts of the body. It is impossible to speed up the process during inflammation, suppuration and other complications.

Rehabilitation phases:

1. Hemostasis. The stage lasts several minutes. Fibrin threads are formed, which stop the outflow of blood from the affected vessels. A pressure bandage applied to the stitched wound can speed up the process.
2. Inflammation. The body must suppress the pathogenic flora that has entered the damaged tissue. Immune cells rush to this area, swelling and a pathological process develop. Duration of rehabilitation: 7 days. It is forbidden to wet the cavity.
3. Proliferation. Collagen and connective tissue begin to form, and a young scar is formed. During the recovery process, it may itch and tug, but does not cause pain. Duration: 4 weeks. It is allowed to smear the seam with creams with regenerating properties.
4. Scar formation occurs within 1 year. Primary collagen is replaced by permanent collagen. The seam changes color from bright red to whitish, and the length stabilizes.

If complications occur, the healing time of the sutured surface increases during sanitation and treatment of pathological processes.

The wound is sutured in a medical facility using special materials and instruments. It is prohibited to use a regular needle to apply stitches.

Timely assistance reduces the risk of consequences.

How to process a postoperative suture

To treat a wound you must have:

1. Antiseptic;
2. Gauze pads or gauze;
3. Tweezers.

Before treating the wound, it should be thoroughly washed so that the wound surface is completely clean. In case of contamination, the first action to be taken is to remove all foreign objects and wash the seams using a weak antiseptic solution. Next you can start processing:

• If ointment is used as an antiseptic, it must be applied with a gauze pad, which after application can be secured with a bandage.
• In the case when the antiseptic drug is in the form of a solution, it is necessary to use cotton swabs, first dipping them into the liquid. The wound surface should be treated with a thin layer.
• After treatment, the wound should not be wetted for three hours. Also, during the first three days after discharge from the hospital, it is also not recommended to wet scars and sutures.

If during treatment it is visible that the seam is oozing, you should immediately consult a doctor for examination and prescription of suitable antiseptic drugs, possibly containing antibiotics. You can speed up the healing of wounds after surgery if you properly care for them, following all the recommendations of doctors.