8.7 SURGICAL COMPLICATIONS
With increasing age skin loses its elasticity and vascularity
making it vulnerable to trauma and it bruises easily. Gentle handling during surgery is therefore
Wound healing may be delayed in older patients, and there
may be a reduction or delayed response in the formation of granulation tissue. Wounds
in older patients may also be more susceptible to infection and patients with evidence
of systemic infection, renal disease, hepatic disease, cardiovascular disease or endocrine
disorders are likely to exhibit delayed wound healing.
Hypoproteinaemia will adversely affect wound healing by
impairing fibroplasia, neovascularisation, remodelling and tensile strength so prolonging
the healing phase. Maintaining a positive protein-energy balin patients before elective
surgery and during the postoperative recovery period is an important therapeutic
objective which might necessitate special feeding techniques in some individuals.
Haemostasis needs to be vigilant during surgery because
local blood losses may seem small if the patient has transient hypotension but could
result in significant postoperative haemorrhage following recovery. Haemorrhage at wound sites
is a major risk factor for the development of infection or dehiscence.
Advancing age, prolonged anaesthesia and surgery time,
hypotension, obesity, some therapeutic agents and the presence of concurrent disease
may all increase the risk of wound infection. The presence of gross obesity may delay
return to normal mobility.