Dressing change after anorectal surgery
First of all, let's talk about the importance of dressing change. The speed of patient discharge is not only related to the method of surgery, but also to the quality of dressing change. Especially for the postoperative dressing of tuberculous anal fistula and complex anal fistula in the anorectal department, the quality of dressing change is very important to how long the patient can be discharged from the hospital and whether it recurs! ! ! ! ! Therefore, the study of surgery is important, and the basic skills of dressing change cannot be ignored.
In order to prevent postoperative bleeding, patients usually relieve their stools 24 to 48 hours after the operation, take a bath after defecation, and then change the dressing. Must pay attention to smooth flow! ! ! ! For early wounds, general dressing change can be used Jingwanhong, moist burn ointment, etc. Its function is to promote the growth of granulation tissue. It is also possible to decide whether to add Yunnan Baiyao or sulfa drugs according to the wound condition. Its function is to clear away heat and detoxify, relieve pain, grow muscles, protect the wound surface, relieve pain quickly, and have strong antibacterial power. For the later dressing change, the dressing can be changed every few days according to the wound condition. When the granulation tissue has grown, the dressing is changed, such as hemorrhoid cream. It is not advisable to change the dressing too frequently. It is very easy to damage the delicate granulation tissue that is newly formed on the wound surface due to the tearing and pulling of the gauze when the gauze is removed. Therefore, as long as the wound does not have abnormal feelings such as fever, swelling, severe pain, etc., the patient should follow the doctor's advice and change the dressing on time.
Second, the dressing change of tuberculous anal fistula and complex anal fistula in anorectal department has a certain relationship with the operation method. Different methods are used to change the dressing. For example, for complicated anal fistulas, some hospitals have drainage strips, but some do not, but use vaseline yellow gauze strips for drainage. So the dressing method is different. However, it must be ensured that the drainage flow is smooth, and the direction of growth is from the bottom to the outside, rather than bridge healing. Tuberculous anal fistula not only requires systemic medication, but also topical medication such as rifampicin, so that the wound will heal quickly! Of course, pay attention to the following points:
1 Cut the infected anal sinus once as much as possible.
2 Note that the main focus healed first after the abscess.
3 pairs of port drainage should be withdrawn daily to withdraw the drainage strip gradually to make the branch tube heal gradually.
4 Diabetes and tuberculosis should be combined with systemic treatment.
Of course, blue light irradiation can also promote wound healing in qualified hospitals!
The experience of antibiotics in the local dressing of anorectal surgery:
1) The application of chymosin in dressing change:
A) For small perianal abscesses, after surgical incision and drainage of pus, gentian or streptomycin plus chymotrypsin 5 mg wet compress can promote the wound healing. The principle is that the medicine can promote fluid, purulent fluid and necrotic tissue, purify the wound surface, facilitate the growth of new granulation, and promote wound healing.
B) Early perianal thrombosis: 5 mg of chymotrypsin can be added to the local anesthetic and injected after the initial part of the thrombus is disinfected to absorb the thrombus and save the pain of surgery.
C) Incarcerated hemorrhoids You can also add 5 mg of chymotrypsin to the local anesthetic, and then add hemorrhoids. Suitable for those who are not suitable for surgery, especially the elderly and infirm. The indications are those who have no thrombosis or only a small amount of formation within 12 hours, no fever in systemic symptoms, no local color change and pain without the need for analgesics.
D) For necrosis, ulcers and adhesions caused by sclerosing agents, genta or streptomycin plus chymotrypsin 5 mg can be used to heal the ulcers, reduce the absorption of inflammation, and relieve the stenosis.
E) For rectal submucosal abscess or radiation proctitis with blood in the stool, kanamycin and chymotrypsin can be used for the former to make it heal quickly. The latter can be used with genta and semycamine to stop bleeding and relieve pain.
2) For perianal abscess caused by E. coli, Qingda infiltration medicine strip is effective
3) Tuberculous anal fistula caused by Mycobacterium tuberculosis. Topical application of rifampicin has a good effect. Pay attention to finding the primary tumor to make the wound heal as soon as possible.
4) Diabetes with anorectal diseases should also be combined with systemic treatment. Pay attention to blood sugar control after surgery.
Let's talk about the application of chymotrypsin plus bupivacaine in the treatment of anal fissures:
Methods: The patient was placed in a lateral position, routinely disinfected, 2-3 ml of bupivacaine was dissolved in 4000u of chymotrypsin, and chymosin was injected into the internal sphincter of the anal fissure and under the anal fissure wound about 1 cm away from the anal margin. If there are more than two cracks, the amount of chymotrypsin can reach 8000u. Inject again after 4-6 days! The effect is definite.
1) Principle: The reason why chymotrypsin has so many magical effects is that chymotrypsin is a proteolytic enzyme extracted from bovine pancreas, which can quickly break down protein, dissolve pus and necrotic tissue, and promote wound healing and postoperative wound healing. . Promote the growth of granulation tissue.
2) The principle of chymosin plus bupivacaine in the treatment of anal fissures
Bupivacaine can relieve pain and relieve the spasm of the internal anal sphincter, thereby reducing the pressure in the anal canal, reducing symptoms, and promoting the healing of anal fissures. It can be applied together with chymotrypsin, which can not only achieve the purpose of painlessness, but also reduce the pressure in the anal canal, reduce symptoms, and promote the healing of wounds and wounds after surgery.
Similarly: the application of bupivacaine and methylene blue in postoperative analgesia in anorectal department is also due to the above effects of bupivacaine! !
Talking about: Dressing change after anorectal department ______ basics
First of all, the disease of anorectal department is generally a second-class incision with second-class healing. The wound recovery is divided into three phases, 1) inflammatory phase, 2) fibrosis phase, 3) epithelial coverage phase, the whole process is 11-30 days. This is the reason why patients in anorectal department usually need to change dressing for nearly a month. ! !
1) The early stage is the 3-5 days after the operation. The wound is mainly inflammatory exudation, so the principle of dressing change in this stage is to clean the wound, remove foreign bodies and pus, make the wound flow smoothly, and reduce the growth of bacteria And the stimulation of secretions to prevent concurrent infection. In principle, the principle of dressing change is to cover the wound with water-based gauze, such as washing with hydrogen peroxide and then wet compress with nitrofural water gauze to clean, penetrate, reduce inflammation, and absorb. Promote the absorption of inflammation. Therefore, the record of the course of the disease should also indicate whether the wound has exudate or bleeding.
2) Mid-term: 5-20 days after surgery, there are very few wound secretions in this period, mainly granulation tissue hyperplasia. Since the granulation tissue has weak resistance to external physical and chemical stimuli and is vulnerable to injury, it is necessary to protect the granulation tissue so as not to affect the healing of the wound. The dressing should be covered with ointment drugs, and some drugs that promote the growth of granulation tissue can also be added, so that the new granulation can be protected from external stimulation. Minimize the use of disinfectants during this period, as this will affect the growth of granulation tissue! ! ! And also pay attention to observe the growth of granulation tissue, whether it grows well, if it grows too much, cut off the part that is higher than the skin! ! ! Therefore, it is necessary to write the growth of granulation tissue on the disease course record! If you still say that there is no redness, swelling, or exudation, and you do not write granulation tissues, you know that your medical record is not serious enough.
3) Later period is 8-25 days after the operation, the wound surface has been basically filled with granulation tissue at this time, the epithelial cells of the wound edge approach the center of the wound surface, and finally cover the wound surface to make the wound heal. The principle of dressing change reduces wound stimulation, protects the growth of epithelial tissue, and prevents the growth of granulation tissue. To protect the surface of epithelial tissue, there is a fibrous membrane that promotes epithelial growth, and intermittent dressing is appropriate.
Operation points of specific dressing change:
1) Guide patients to relieve psychological burden. Everyone who has changed the dressing knows that the patient needs to cooperate with the change, so the patient must be guided, especially the initial dressing change. Don't increase the patient's worries, fears, or even doubts about you!
2) Washing of wounds Generally, it is not necessary to clean, but for perianal abscesses and other wounds, there are many secretions and necrotic tissues should be cleaned. The method is generally to use normal saline (also can use nitrofurazone, hydrogen peroxide, etc.), clean the wound from top to bottom, inside and outside, to clean purulent secretions, reduce the bacteria on the wound surface and the continuous anti-inflammation of drugs effect.
3) Observation and treatment of wounds Pay attention to the changes of wounds when changing dressings, and take timely measures to remove factors that hinder wound growth. Ensure that wounds live in a good environment.
A) Corrupted tissues should be removed to reduce the chance of bacterial reproduction and accelerate wound healing!
B) For deep and large wounds, the dressing should be changed every day, and the drainage strip should be drained to the bottom to prevent false healing and bridge healing!
C) For the granulation of edema, one can use hypertonic saline wet compress, or use antibacterial water gauze.
D) If the granulation color is not good, you can use Jingwanhong and other drugs
E) If it is difficult for wound growth, you can refer to another dressing post in my doctor for application, such as the application of chymotrypsin.
Contraindications of dressing change
1) Guide patients to relieve psychological burden. Everyone who has changed the dressing knows that the patient needs to cooperate with the change, so the patient must be guided, especially the initial dressing change. Don't increase the patient's worries, fears, or even doubts about you! Put an end to the "three fierce". "Three Meng" refers to wiping, stabbing, and slamming! This will aggravate the injury and even make the wound unhealed for a long time. Increase the patient's discomfort. Of course, this kind of situation is more common in internships and advanced studies, but it is still necessary to point out that I often see some doctors, the patients do not communicate well, the anus is tight, and as a result, the dressing changes are rough and the patients are miserable! 1) When changing the dressing, the wound should be fully exposed, and the anus should be stabbed into the anus without seeing clearly, and the movement should be gentle and gentle so that the medicine can reach the wound. For anal fissures and anal fistulas, the incision should be inserted parallel to the bottom of the wound. When encountering resistance, first avoid the incision and penetrate through the anus, then insert the probe into the bottom of the wound, and then pull it out from the inside to the outside. Corresponding to what I want to do is - stab. 2) The filling should be filled naturally when it reaches the bottom of the wound. It is advisable not to be loose or tight, and it cannot be "struck", which may even cause artificial damage. 3) Clean the wound gently and not violently. This will damage the new tissue and increase the patient's fear. The big irritation also makes the granulation tissue edema.
Treatment of special wounds
1) The treatment of high complex anal fistula It is very important that the first operation of high complex anal fistula is performed. Similarly, dressing change also plays an important role in its cure! High complex anal fistula is still difficult. First of all, it is necessary to promptly remove the drained secretions and cut tissue residues, and prevent premature healing of the wound base and form false healing. Therefore, while changing the dressing as much as possible to expose the wound, the secretions and cut tissue residues should be discharged in time. For those with severe infection and more secretions, use normal saline to clean the wound from top to bottom, inside and out.
2) The treatment of the open section of the complex anal fistula is mainly through the removal of the primary foci of the main duct, the adhesion of the branches and the absorption of necrotic tissue to achieve the purpose of healing. In 2 days after surgery, the exclusion strip can be pulled out, and the exclusion section of the pipeline can be slightly pressurized. Do not do too much stimulation on the open section of the pipeline, which will stimulate the cavity and affect adhesion.