msyamp
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3. contaminated wounds secondary closure.
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| yasmeen
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3 CONTAMINATED WOUNDS SHOULD,NT B CLOSED
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| achilles
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i'll go for 3 too but i was confused about if closure of muscles only should be done in such a situation or not ??
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| AAAAA
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I did emergency medicine rotation and you leave the wound open and never close the wound if more than 12 hours. Because it is infected wound, if you close the infected wound, you get systemic infection, sepsis.
My chief resident in the ER rotation had closed wounds that came in on Sunday when those guys had bar fight on Saturday late night (Sunday morning 1:00 a.m. bar fight) but they are still within the 12 hours window.
If more than 12 hours, we send the patient to the surgery clinic on Monday ! I never close a late infected wound in the ER per Chief Resident of Surgery at Vanderbilt University.
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| AAAAA
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Here in MCC (Canada) you really don't know how long the wound have been around, 8 hours window, always cleanse the wound with Ringer's and also with sterile water and give Td and possible antibiotics, NEVER CLOSE THE WOUND ! NEVER ! SEND THE PATIENT TO THE SURGERY CLINCI
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| Rasul
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In this case time lapse is 8 hours, that' s why I'm in doubts. According to guidelines in my country: 6 hours is OK to close, 6-12-Ok to poor AB and close(you have to dissect the edges of the wound to make them fresh), 12 h-do not close.
But see, I was never really good in surgery, was good at anesthesiology though.
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| AAAAA
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6-8 hours is probably the cut-off in North America for suturing the would.
I would not suture the wound if the edge is bluish-discoloration and over 8 hours.
(I have done close to 8-12 hours wound suture if OK with the Chief Resident in the ER but very rarely. I remembered 2 cases Also never in the face, the question here is really about anatomy.)
The cut penetrated the deep fascia and muscle. Once the wound penetrated the deep fasica, YOU NEVER CLOSE YOURSELF. LEAVE IT OUT AND LET THE SURGEON DOES IT !!!!
They need surgery room to massive wound cleansing in this case. I re-visited this question and looked for "code words" and hints. No way you close it in the clinic or ER.
Leave it open to let the "granulation process" to close.
But always tell the patient you come in very late, there is a chance of infection, poor wound healing and scars !!
Always protect yourself !!
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| AAAAA
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During the surgery rotation, I learned any wound that penetrated the deep fascia and muscle may involve the vascular structures and nerves. So you need the surgeons and if any nerve damage and vascular compromise, you call the vascular surgeon and also the "neuro-vascular surgeon" in the university to come to take a look.
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| achilles
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thanks AAAAA...then how does the muscle heal ? and is there any compromise in the function of the muscle ? and i just wanted to make sure of this point - deep cleaning of the wound is done by the surgeon in the OT and then the muscles are sutured...is that right...
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| AAAAA
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I did surgery and the Chief told me muscle never heal back together.
The Chief just use a suture to pull the muscle together.
That's why in surgery, he always told me to cut the muscle longitudinally and never horizontally. (never cut any muscle at all , NEVER NEVER) In emergency surgery like C-section, I remembered taking the baby out in less than 18 minutes 20 seconds , the fastest time from door to baby crying. It is called DOOR-TO-DELIVERY TIME. In some cases, you tell the Mom the muscle in her abdomen was cut in order to save the baby's life and she will have abdominal muscle weakness.)
If the muscle is severed, you can not put it back together and the patient normally will have permanent weakness due to poor healing of the muscle.
I learned that in medical school though.
(I still remembered it was a scare moments to go into surgery room and the surgeons' presence scared the hell out of me. But again only a few are jerks. The jerk became the Chairman in my medical school now. So the bad guy always become the Chairman of the Surgery LOL
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| Rasul
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True about the bad guys. Have You ever met a surgeon with antisocial personality disorder?...I did...Baaaad...
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| AAAAA
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Most of them are bad, they want to tell you they are better than the rest of you.
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| AAAAA
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Why the surgeons are nice to the female medical students ?
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| achilles
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thanks AAAAA...
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" it's not whether you get knocked down, it's whether you get up"
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| Rasul
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Are they? I didn't notice?...
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| frontal
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Bad people getting good positions...it happens it happens...
Determine, what's the answer. It's a toughie.
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