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Department of Surgery & Obstetrics

College of Veterinary Medicine
University of Mosul

Nosocomial infection

Infection that are acquired by the patient during the course of hospitalization
These infection may occur in anatomical sites other than the surgical wound and may developed preoperatively, postoperatively or even after the patient has been discharged

Department of Surgery & Obstetrics

College of Veterinary Medicine
University of Mosul





Hemorrhage and Hemostasis

Department of Surgery & Obstetrics

College of Veterinary Medicine
University of Mosul

Hemorrhage and Homeostasis

Loss of blood from the vascular system may be result of diapedesis or rhexis. Control of bleeding is very important because, Aside from anesthetic problems, the only problem in surgery is bleeding. Bleeding is eventually accompanied by shock, and loss of red blood reduce the oxygen carrying capacity of blood

Department of Surgery & Obstetrics

College of Veterinary Medicine
University of Mosul

Causes:

1- penetrating wound
2- Incisions
3-Contusions or laceration
4- Blood may fail to clot within normal time because, Liver disease, irradiation, chemical poisoning, Walfarin, phosphorus, arsenic


Department of Surgery & Obstetrics
College of Veterinary Medicine
University of Mosul

Types of Hemorrhage:

According to source

Arterial hemorrhage

Blood is bright red, and flow under pressure

Venous hemorrhage

Blood is bluish-red and flow freely

Capillary hemorrhage

The blood oozes under very low pressure

Department of Surgery & Obstetrics

College of Veterinary Medicine
University of Mosul

According to time of occurrence as

Primary hemorrhage
Occurs at the time of injury

Intermediate hemorrhage

Occurs within 24 hours of injury
Secondary hemorrhage
Occurs more than24 hours after initial injury, usually result of necrosis, ulceration, occur due to slip ligature

Department of Surgery & Obstetrics

College of Veterinary Medicine
University of Mosul

According to extent

Petechial hemorrhage
Small hemorrhagic areas within skin, serosa, mucosa

Brushing bleeding

Which refers to larger areas of subcutaneous or submucosal hemorrhage
Deep hemorrhage
Which refers to extravasations into soft tissue.

Department of Surgery & Obstetrics

College of Veterinary Medicine
University of Mosul

Haemostais

Process of Hemostasis
Vascular injury
Platelet adhesion and activation
Platelet aggregation (1o hemostatic plug)
Fibrin formation via cascade (2o hemostasis)
Clot retraction (thrombasthenin)
Fibrinolysis and healing

Role of Platelets

Surveillance for vascular integrity
Formation of 1o hemostatic plug
Activation of 2o hemostasis
Healing

Department of Surgery & Obstetrics

College of Veterinary Medicine
University of Mosul

Hemostasis

There are at least 3 factors involved in the spontaneous arrest of bleeding
Extravascular:
Location of vessels, elastic nature of surrounding tissue, vessels passing through bone or cartalige are protected, vasoconstriction tend to reduce hemorrhage
Vascular:
When B.V injured the intima rolls inward and vessels end retract, provided suitable surface for accumulation of platelet and clot formation

Intravascular:

A series of blood clotting factors become activated when blood platelets undergo morphological changes in the presence of damaged endothelial tissue.

Department of Surgery & Obstetrics

College of Veterinary Medicine
University of Mosul
Mechanical arrest of haemorrhage
1-Crushing
2-Torsion: can be twisting vessels by artery forceps
3-Ligation: This involves tying the end of bleeding vessels to prevent further escape blood materials which used same which used in suture
4-Suturing: Although suturing is used primarily to appose wound edges
5- pressure: Bleeding from surgical incision can be stopped by pressing a gauze sponge against the bleeding point
6- Tourniquet: by constricting band , should used for short time, tourniquets should be released every 20 minute
7- Electrosurgery and Electrocoagulation, Thermocautery burns tissues, and the coagulated tissues act as hemostatic plug

Department of Surgery & Obstetrics

College of Veterinary Medicine
University of Mosul
Hemostasis with topically applied substances
Substance have an astringent effect on tissue and blood vessels, applied topically to small cut, example feeric sulfate, feeric chloride, glacial acetic acid, silver nitrate, alum, tannic acid
Specific coagulant:
Gelfoam is a spongelike substance which a large surface on which blood will clot, topical thrompin is specific coagulant factor
Systemic hemostatic agents:
Vit K is necessary for formation of prothrombin, and helpful in preventing excessive hemorrhage

Department of Surgery & Obstetrics

College of Veterinary Medicine
University of Mosul
Wound

Department of Surgery & Obstetrics

College of Veterinary Medicine
University of Mosul
Wound:
A traumatic separation of skin, mucous membrane or organ surface.

Loss continuity of skin, mucus membrane

Closed wounds
Contusions
Abrasion

Open wound:

Incision
Laceration
Puncture
Penetrating

Department of Surgery & Obstetrics

College of Veterinary Medicine
University of Mosul
Closed wound:
Abrasions:
These wounds result from scraping or friction applied to the skin. Surgical intervention is unnecessary
Contusions:
In these wound the skin is damaged but remains unbroken. Only connective tissue may be damaged, it is possible that muscles, tendons, nerve and even bone are involved.

Department of Surgery & Obstetrics

College of Veterinary Medicine
University of Mosul
Closed wound:
Abrasions:
These wounds result from scraping or friction applied to the skin. Surgical intervention is unnecessary
Contusions:
In these wound the skin is damaged but remains unbroken. Only connective tissue may be damaged, it is possible that muscles, tendons, nerve and even bone are involved.

Department of Surgery & Obstetrics

College of Veterinary Medicine
University of Mosul
Open Wounds
Incisions wound:
Whether planned or accidental, incision are made by sharp object. The tissues are cleanly, and bruising of the margins is minimal

Laceration wound:

A laceration are made by a blunt object that tears tissue, some laceration produced a skin flap, or subcutaneous pocket, some laceration produce skin flap
Punctures wound:
These wound are caused by sharp-or blunt pointed objects, usually deep but have small opening. Foreign material may be detection







Department of Surgery & Obstetrics
College of Veterinary Medicine
University of Mosul
Penetrating wound:
These wound communicate with the body cavities, they may result in internal infection such as peritonitis or empyema

Open Wound Classification

• depended on the time.

Clean Wounds

Most common is elective surgical incision
Primary closure
1-5% rate of infection

Clean Contaminated

Wounds contaminated by local flora despite aseptic technique
Cholecystectomy, appendectomy and hysterectomy
3-11% infection rate

Contaminated

Open traumatic wounds in nonsterile environment
Open fractures
Surgical procedures in which there is a gross deviation from sterile technique (emergent open cardiac massage)
10-17% infection rate


Dirty or Infected
Gross/heavy contamination or active infection
Perforated viscera, abscess and traumatic wounds
>27% infection rate