So while reading up on appendectomies (a friend just had laparoscopic surgery), I was reading about open surgeries, and there was mention of (in the case of ruptured appendices) leaving the surgical wounds open for drainage or inserting/installing a drain tube.
Okay, so I figured once they wash your guts (“peritoneal lavage” they called it), they need there to be some kind of escape for excess fluid. I understand the “drain” tube thing, but what exactly does “postoperatively leaving the wound open” mean exactly?
You just have an open gash in your belly and they keep change dressings until it closes on its own? How long would that take? (And a childish related question: would there be any risk of your belly staying open forever?) Do they use any kind of sutures?
I tried looking it up but it started making me feel too whoozy.
P.S. My buddy is fine and it seems he’ll be discharged today (not even 24 hours later). He had a totally uncomplicated case of appendicitis, no open wounds for him.
Just an anecdote: My uncle had to have emergency surgery (at age 82, for the second time in ten days) for an abscess that formed when his colon was removed (really bad diverticulitis). He was laid open for a long time while he healed “from the inside out.”
So… after “peritoneal lavage” they would leave the wound open and the saline would ooze out? Or do they suction most of it out first? And then, aside from sterile bandages covering things up, your colon would be exposed? (Ook. Whoozy again.) This is mind boggling to me, I always figured everyone had their surgical incisions (or sword wounds) sewn up.
Is there be a greater risk of infection from leaving wounds open or would it be good to have it open so you can go back and debride more easily? (Like if you had a gangrenous appedix removed).
ETA: Wait, wait, wait. In Khadaji’s thread link, someone mentions packing gauze into a wound??? How much does that hurt the patient?
Another anecdote: I have a scar on my ankle that I was too stupid to get stitches for, from a glass slice. It’s an inch long and just under a half-inch at the widest. I remember clearly as it was healing, it healed from the inside out. It stopped bleeding relatively quickly, and just started building up the scar from the internal tissue. I kept it completely covered for the entire time, and mostly dry.
I didn’t feel it at all. I had no feeling whatsoever in the wound. At first it was difficult for me to make myself put the gauze in, but it got to be old hat after a while. At first we would have to soak the gauze in sterile saline. Then pack it all tight and tape it down. After some healing we just packed it and taped it.
Yet another anecdote: I kept getting anal fisures that would result in these huge boils right by my anus. (We are talking almost the size of a small chicken egg, very impressive when they burst)
The decision was made to remove the fisure via surgery. I was taken into the OR and they knocked me out (thank OG)
The surgical team then used a baseball bat as a dildo on my ass. At least that is what if felt like when the pain killers wore off.
After the fun wore off that, they cut a V shapped notch to remove the fisures.
The notch was left open and covered with gauze and then taped up. You know that shower scene in the coneheads where Beldar had no butt crack? Pretty much how my ass looked when I left the hospital.
A day or so later the first delivery from my intestines arrived for processing.
:eek: :eek: :eek: :eek: :eek:
You know that thread we a week or so ago about hot peppers and how they make your ass hurt? Trust me when I tell you, those guys don’t know what having your ass on fire really feels like.
It pretty much felt like my truds were wrapped in barbed wire, and soaked in gasoline. Oh did I mention the gas was ignited from the friction as it passed?
It took almost two weeks before it was healed, but I am happy to report everything has been normal since.
Oh, and FTR Tucks pads are prehaps the greatest invention in the history of mankind.
Me too!
Insanity is doing the same thing over and over again expecting a different result.
Insanity is doing the same thing over and over again expecting a different result.
Insanity… What?
I find myself packing wounds at work on a somewhat regular basis.
We usually find a wound that is swollen with hard edges and perhaps some bruising. More often it is a wound that continues to ooze or drain through its stitches or staples. Sometimes we find the wound opening when we go to removed the staples a couple of days after the surgery.
Usually, the Doc will open the incision/wound with a 'sterile swab (a ling “Q-Tip”). Some Docs them spray sterile water around inside the open wound to clean out any old blood clots that may be preventing the wound edges from adhering to each other. Most often, teh wound is clean looking and we just pack the wound with gauze that has been wetted with sterile water or 20% acetic acid.
Typically the doc will do one dressing change a day and the nurses will perform the others.
That is called a wet-to-dry dressing change and we usually change the dressing about 3-4 times a day.
Sometimes we train a family member to do the dressing change at home (which I don’t care for).
After rinsing off the intestines with sterile saline, the majority of the saline is suctioned out of the abdomen. It is difficult and pointless to try to remove every last cc of fluid because the peritoneum produces and absorbs a fair amount of fluid on a daily basis anyway. Your abdomen is not normally awash in fluid, but the excess is quickly absorbed unless there is some other factor involved.
The abdominal wall is composed of layers of muscle, tendon, fat, and skin. The abdomen is also lined with peritoneum, which is pretty thin and about as tough as saran wrap. In closing the abdomen after a surgery, the tendon layers of the abdominal wall are sewn together. We normally don’t sew muscle to muscle since the fibers just split apart under tension. The fat also doesn’t hold sutures worth a damn. The skin is quite tough and also gets closed with glue, sutures, or staples. All in all, there can be several layers of sutured material between open air and your guts.
If an abdominal wound has to be opened for some reason, it is typically just the skin that is unzipped, leaving the deeper layers intact, so no guts pour out. If the tension-bearing layers split open, we call it a dehiscence and guts frequently do pop out. Drains can be as simple as a strip of latex or silicone that is tucked between stitches or passed through a separate puncture wound, or as complex as multi-port coaxial catheters meant to deliver and remove irrigation fluid or antibiotics to a closed space. Normally, the hole that they leave in the abdominal wall is small enough, and the tissue resilient enough, that removal of a drain does not lead to the formation of a hernia at the site. Abscesses between the skin and the tendon layers are normally just flayed open and allowed to heal from the bottom up; abscesses deep to the tendon layers are typically treated with drains or surgical exploration followed by drains.
Unsurprisingly, open wounds are initially painful because of all the little nerve endings sitting out in the open air. However, granulation tissue (the reddish tapioca-looking stuff that grows in the wound bed and eventually forms a mature scar) grows much faster than any regenerating nerve fiber, so the nerves get covered and the wound surface becomes pretty much numb. Epithelial cells (skin) slowly spread from the edges of the wound to cover the wet surface of the granulation tissue, and the granulation tissue contracts over time (it has a lot of smooth muscle cells in it) to shrink the wound.
If the abdomen is grossly contaminated with stool or pus, then the likelihood of an infection in the layer of fat between the belly muscles and the skin may be high enough that the surgeon would chose to leave the wound open in the first place (the skin part, anyway) rather than let an abscess develop there and then open it later.
It is my understanding that skin infections which are surgically drained are often, if not usually, left open to heal from the inside out (or bottom up as you prefer) to avoid their closing and re-abscessing. You hear a lot more about this lately with the prevalance of community-acquired MRSA.