Question

CASE STUDY 4 Dorothea just had her ruptured appendix removed. The skin and subcutaneous layers of her wound have been left open. Her surgeon told her that if her wound showed no signs of infection in five days, he would finish the closure. She will return to his office later for removal of her skin stitches at her postoperative visit. 1. During the surgical procedure, the surgeon grasps the appendix for removal. The mesoappendix is clamped with hemostats, incised, and a stick tie is used to prevent bleeding. He then asks for a suture. Why would he use a purse-string stitch at the base of the appendix? 2. Why did the surgeon leave the wound partially open and insert a penrose drain? In its present condition, by what method is the wound expected to heal? 3. When will the surgeon possibly close the wound? How will the surgeon determine if Dorothea's wound may be closed in five days? 4. If the wound can be closed in five days, what type of healing will then be expected? What is the expected amount of tensile strength that can be regained? 5. As the surgeon works, he talks about Professor Halstead. What contributions did he make that are being applied to this situation? O 2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated. or postod to a publicly accessibie wehsie, in whole or in part

Answer 1

1) Appendix is first part of the colon, it consists of lymphatic tissues that helps in immune function.Appendix termed as worm like appendage. Appendicitis is the inflammation of the appendix. Any blockage secondary to cancer and chronic constipation are the common cause for appendicitis. Chronic appendicitis can be treated with surgical removal. In an open appendectomy purse string suture is used to invert the stump of the appendix after incision as it requires one operator,simple technique,and consumes short time with no special equipment.

2) Penrose drain made of flexible rubber tube to drain buildup fluid in surgical site. Penrose drain inserted into the surgical site one end will come out of the incision. As small tab is left at the wound end to prevent dislodging of the drain. When no drain is found for 24 hours it is ideal to remove the Penrose drain.

3) Surgical wound is an opening made as a result of surgery. A surgeon make incision in the tissues and once the procedure completed the cut edges are secure together with stitches,staples or glue. The closure of wound done when the wound site heals and healthy,absence of necrosis,pus discharge,edematous, absence of drain for a duration of 24 hours. The client doesn't have any sign of infection.

4) Tensile strength of wound increases as the day progresses. In 5 days of postoperative day the the tensile strength of the wound increases by 80%. Tensile strength is determined by collagen formation.