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Obese patients undergoing cholecystectomy wound complications

The average exposure of 2.2h, El per gram of tissue injury in the small seedlings inoculated with l0. The data were l1 two cases of wound infection, 4 down incision pus culture positive bacteria, while the bile bacterial culture were negative. That bacterial contamination is caused by exogenous elective cholecystectomy wound infection is an important factor. In addition, because abdominal obesity mesenteric, omental fat hypertrophy, an increase in abdominal contents,[link widoczny dla zalogowanych], increasing the tension of the incision, but also negative factors in wound healing effects of obesity on wound healing are not limited to local,[link widoczny dla zalogowanych], but also to the many systemic factors. Functional activities, such as obese people require more physical exertion, body oxygen consumption increased. Obesity can also have a wide range of respiratory effects, including throat are easy to block fat cool upper respiratory tract; obesity can cause chest full compliance down at the end, abdominal pressure increased mechanical activity limited to the diaphragm and lung functional residual capacity decreased, the above results can cause lung ventilation and gas exchange dysfunction, leading to lack of O and COz body retention. often accompanied by elevated blood lipids, causing systemic atherosclerosis, not only weaken the body's immune function, but also by inflammation, arteriolosclerosis so prone to blood clots after stimulation, but also can cut local blood incision in obese patients affected by two concurrent disease prevention in laparoscopic cholecystectomy is not yet universal, and completely replace laparotomy cholecystectomy before the incision is still a serious complication of the rehabilitation of patients after cholecystectomy, can not be ignored. We note the areas of clinical practice experience, helps to reduce fat 』patients undergoing elective cholecystectomy wound complications ① Cut technology: the obese patients undergoing elective cholecystectomy should choose the right costal margin of the oblique cut, cut off the blood vessels and the abdominal wall nerve less conducive to wound repair; also increased intra-abdominal pressure encountered cases, oblique incision on one side by the costal arch fixed, can reduce the incision under tension, to prevent splitting. Skin incision, the scalpel of subcutaneous fat applied to the probe layer a cut, do not repeatedly cut, causing excessive subcutaneous fat damage. Do not burn electricity Yun edge of the deep surface layer of fat, not fat burning electric knife wound to stop bleeding directly, but with a small vascular clamp clamp the bleeding vessel and surrounding tissue,[link widoczny dla zalogowanych], stop bleeding by electrocautery hemostat in order to avoid large pieces of fat tissue necrosis and liquefaction. Difficult case of surgical field exposure, the incision extended rather choose not to violence and stretch incision, resulting in tissue injury; or in extremely difficult circumstances, surgery, operation time counter to be extended. ② incision suture: obese adipose tissue because omental and mesenteric thickening, peritoneal contents and more options as far as possible completely relaxed under general anesthesia in the case of abdominal wall eversion suture continuous ambulatory peritoneal layer. Avoid peritoneal tear, reducing line end residues. Gallbladder surgery in case of damage, bile were cut pollution, cut the available physiological saline, to avoid bile cause chemical stimulation of the incision and reduce the potential carrier of bile contamination of the wound tissue Sockets Layer closure, elastic fit,[link widoczny dla zalogowanych], muscular layer and skin closure of the Do not embedded in adipose tissue between, not to cause wound healing and dehiscence. Estimated postoperative cough, prostatic hyperplasia, Pai feces increased abdominal pressure and other factors difficult to those who choose straight incision in the peritoneum can be applied for Wo Chang suture ③ after treatment; given early after oxygen, to improve the obese patients respiratory insufficiency, and wound by increasing oxygen partial sheets, which will help clear the bacteria in the wound. Avoid coughing,[link widoczny dla zalogowanych], urinary retention, which may result in increased intra-abdominal pressure factor. With older persons athletic bandage abdominal incision suture removal after an appropriate extension of time