8.7SURGICAL COMPLICATIONS 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 advisable.

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.