QuizMe 13

Wound Management

A 35-year-old obese nulliparous woman underwent an open myomectomy through a vertical midline incision. A couple of weeks later, the patient presented for follow up complaining of incisional pain, local redness without any fever. Her vital signs were unremarkable and the incision is intact with moderate periumbilical drainage, erythema, and tenderness.

  • Obese
  • Post-open myomectomy
  • Periumbilical drainage and local redness

Wound infection

  • Admit her with IV antibiotics
  • Oral antibiotics and discharge
  • CT abdomen and pelvis
  • Exploration of the incision

Exploration of the incision

Wound infections are one of the most common complications for the practicing obstetrician–gynecologist with rates of approximately 12% in the postoperative period.Some of the known risk factors for wound infection include the following ; obesity ,smoking ,diabetes, and longer operations.

 

Identification of the depth and breadth of infection is the first step in the management of patients with local wound infection. In order to limit progression and worsening of the wound infection, complete assessment of a surgical wound should be done. 

Myomectomy and post-cesarean incisions have been characterized as clean-contaminated incisions.Preventing wound infection in a clean-contaminated surgery involve antibiotic prophylaxis and intraoperative antiseptic techniques.

  • Recommendations | Surgical site infections: prevention and treatment | Guidance | NICE. (n.d.). 
  • ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol. 2009 May;113(5):1180-1189. doi: 10.1097/AOG.0b013e3181a6d011. PMID: 19384149. 
  • CDC, Ncezid, & DHQP. (2021). Surgical Site Infection Event (SSI). https://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/ImportingProcedureData.pd
  • Wloch, C., Wilson, J., Lamagni, T., Harrington, P., Charlett, A., & Sheridan, E. (n.d.). Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. https://doi.org/10.1111/j.1471-0528.2012.03452.x
  • Gillespie BM, Bull C, Walker R, Lin F, Roberts S, Chaboyer W. Quality appraisal of clinical guidelines for surgical site infection prevention: A systematic review. PLoS One 2018;13:1–17. https://doi.org/10.1371/journal.pone.0203354.
  • Steiner, H. L., & Strand, E. A. (2017). Surgical-site infection in gynecologic surgery: pathophysiology and prevention. American journal of obstetrics and gynecology, 217(2), 121–128
Author

Dr Aya Al-Shati & Dr Mustafa Qasem & Dr Nouf Khalifeh

Reviewer

Mr Moiad Alazzam