Читать книгу Complications in Equine Surgery - Группа авторов - Страница 134

Dehiscence can occur from the immediate postoperative period up to several weeks after surgery. Dehiscence during the anesthetic recovery or soon after surgery can be a result of self‐induced trauma or inadequate steps to immobilize the region, confine the patient, or relieve tension on the suture line as appropriate. Most commonly, incisional dehiscence will occur 4–5 days postoperatively [5]. Clinical signs that may develop prior to dehiscence include serosanguineous discharge or in the case of an infection, a purulent odorous discharge. Tissue swelling, heat, and necrosis of the sutured tissue edges along with pain to palpation may also be evident prior to dehiscence. Dehiscence is diagnosed at the time where there is superficial or deep and partial or complete separation of the previously sutured wound or incision. Identifying any primary cause for the dehiscence before assuming it was a result of infection is important, since with incisional disruption and dehiscence there is often secondary infection present [5]. Clinical signs associated with incisional infections include incisional swelling, heat, pain, and drainage of a purulent nature [13]. If there is a suspected infection present, regardless of whether it was the primary cause or secondary to another cause, a deep swab should be obtained of the infected area after aseptic preparation [6]. The swab is then submitted for aerobic and anaerobic bacteriological culture and sensitivity testing. In some cases, a fungal culture is recommended. The degree of bacterial contamination will help determine the most appropriate wound management, thus qualitative and quantitative cultures can be beneficial [7]. If a foreign body and sequestra is the underlying cause of the dehiscence, it can be identified or ruled out with a number of diagnostics, including manual exploration and probing, ultrasound, contrast or plain radiographs, CT, or MRI of the wound [7]. If self‐mutilation was the cause of the dehiscence, it is usually diagnosed through observation or evidence of a rough anesthetic recovery, rubbing, biting, or pawing [6]. Cytological or histopathological examination may be indicated to identify an underlying cause such as neoplasia [5].