Clinical Case
Dr. Chen from the Department of General Surgery has a patient named Lao Liu. Lao Liu just underwent open surgery for intestinal obstruction, and the nurse informed him to get out of bed and move around as soon as possible after the surgery. But Lao Liu refused to get out of bed because he was afraid of the pain of the wound and even more afraid that getting out of bed would cause the wound to crack open. After Dr. Chen, the supervising doctor, learned about it, he quickly told Old Liu the correct way to get out of bed and move around. This effective method not only avoids wound pain during movement, but also promotes intestinal peristalsis.
Do you also want to know about this method? Let's take a look at what Dr. Chen said!
Let's first learn what is incision dehiscence?
Surgical incision dehiscence refers to the phenomenon of full-thickness incision dehiscence caused by various systemic and external factors during the early postoperative period when the incision has not yet healed. It is usually more likely to occur in patients with poor overall nutritional status and older age.
So, what are the factors that cause the wound to split open?
1、 Systemic factors
1. Malnutrition and poor tissue healing ability, including hypoalbuminemia, anemia, etc.
2. Advanced age: Elderly patients usually have weak abdominal walls, poor abdominal wall tension resistance, and are often accompanied by symptoms such as hypoalbuminemia and cough caused by underlying cardiovascular and pulmonary diseases;
3. Obesity: Obese patients often have weak abdominal walls, relatively poor tissue healing ability, and are prone to incision fat liquefaction.
4. diabetes: diabetes patients have poor tissue healing ability, and have a high risk of fat liquefaction and incision infection;
5. Long term use of steroid hormones, immunosuppressants, and smoking: These factors can reduce tissue healing ability;
2、 External factors
1. Postoperative intense activity: such as waking up too quickly, carrying heavy loads, etc;
2. Postoperative increase in intra-abdominal pressure: If the surgical incision is located in the abdomen, when the patient has behaviors that can easily cause an increase in intra-abdominal pressure, such as forced defecation, severe coughing, vomiting, etc., the incision in the abdomen will be stretched open, accompanied by severe pain, secretion leakage, and other symptoms. Inflammatory bowel paralysis can cause bloating, severe coughing, and forceful defecation;
3. Early suture removal: For patients with high-risk factors, the suture removal time can be appropriately extended; If the suture used for the incision after surgery is thin, the suture is not firm, and the incision tissue is not perfectly aligned, it can also lead to poor wound healing and cause the incision to crack after surgery.
4. Incision fat liquefaction and infection: It takes some time for the skin protective barrier to fully repair. If the incision site is not properly protected after surgery and is infected by pathogenic microorganisms such as bacteria and viruses, it will affect the normal healing of the incision and cause the incision to crack. Will lead to poor wound healing and reduced tensile strength;
Although surgery may cause incision dehiscence, mastering the correct method can avoid accidents. How to prevent incision dehiscence?
1. Before surgery, try to correct factors such as hypoalbuminemia and anemia in patients through high protein diet and intravenous infusion, so that the raw materials for tissue healing are more abundant.
2. Quit smoking before operation and actively control blood sugar of diabetes patients; If not necessary after surgery, stop using steroid hormones and immunosuppressants;
3. After surgery, abdominal straps should be used to protect the incision. Obese patients should use multi head abdominal straps with sufficient tension, especially when getting out of bed and defecating. The abdominal straps should be tightened.
4. When waking up and lying down after surgery, move slowly and gently. When coughing and expectoration, in addition to using a abdominal belt, use both hands to press the outer abdominal wall towards the middle to reduce abdominal wall tension. To prevent postoperative incision dehiscence caused by increased intra-abdominal pressure or joint movement, and to avoid strenuous activities.
5. Avoid exerting force during postoperative defecation, and use enema or enema to induce defecation. Patients with benign prostatic hyperplasia can delay the removal of the urinary catheter.
6. After surgery, pay attention to the condition of the incision. If there is pain, redness, swelling, or leakage, report to the doctor or nurse in a timely manner. Early treatment of incision fat liquefaction and infection should be carried out to avoid affecting the entire incision.