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Old 07-30-2012
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Question Why did the surgeon leave the wound partially open?

A 65-year-old woman was driving her car when she came upon a railroad crossing. Despite the fact that the gates were coming down, she attempted to cross the tracks. The train hit the front of her car and carried it (and her) several thousand yards down the track. She was extracted from the car with multiple injuries, including two broken legs, a fractured pelvis, and internal bleeding due to a ruptured spleen and fractured liver. She was life-flighted to a level 1 trauma center, where multiple surgeries took place, including splenectomy and repair of her liver lacerations. Ten days post-operatively, while still in the intensive care unit, the sutures of her abdominal wound broke down, due to wound infection with Pseudomonas aeruginosa. She was taken back to surgery, where retention sutures were placed, but a portion of the abdominal skin wound was left open, after closure of the peritoneum, and was packed with iodoform gauze. What was the surgeon hoping to accomplish by leaving the abdominal skin wound partially open?

a) To allow easy re-entry
b) To allow eradication of Pseudomonas by contact with air
c) To allow healing by secondary intention
d) To drain off blood from the abdomen
e) To reduce of scar size
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Old 07-30-2012
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C
Excluding other options
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Old 07-30-2012
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C....allow infected wounds to heal by secondary intention
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Old 07-30-2012
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Why cant it be B?
C was my second option.
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Old 07-30-2012
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Quote:
Originally Posted by Doc4Step1 View Post
Why cant it be B?
C was my second option.
Why would pseudomonas die because of air? Its an aerobic organism.
I'd go for C too
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Old 07-30-2012
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Quote:
Originally Posted by smanthrav View Post
Why would pseudomonas die because of air? Its an aerobic organism.
I'd go for C too

OoooOooOpsss....My Bad.I thought its anaerobic.

Ok I will use my second option then.

C is the right answer.
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I would say C as well.
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Ddd
The wound will heal by secondary intention but the major reason for leaving it open should be to make the environment unfavorable for intestinal anaerobes
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Quote:
Originally Posted by imgchuchu View Post
Ddd
The wound will heal by secondary intention but the major reason for leaving it open should be to make the environment unfavorable for intestinal anaerobes
You mean B right ? Cos D is "to drain BLOOD from the abdomen"....I would have gone for D if it would say "To drain Exudate or Puss from abdomen".
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Old 07-31-2012
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Correct Answer correct answer :)

The answer is c) To allow healing by secondary intention

Secondary intention is the slow granulation of the wound from the bottom up, and discourages growth of anaerobic bacteria, commonly extricated by extensive abdominal operations.

As for B) - Pseudomonas is not an anaerobe, and requires treatment with an anti-pseudomonal penicillin or 3rd generation cephalosporin and an aminoglycoside

As for D) - Normally, drainage tubes are inserted for this purpose. Besides, primary closure of the peritoneum would prevent good drainage through the wound.
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