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Post Operative Complications

Post Operative Complications. Miss Meg Birks Consultant Hand Surgeon GP Education event 1 st March 2012. Immediate Complications. Bleeding Apply direct pressure Elevate the hand

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Post Operative Complications

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  1. Post Operative Complications Miss Meg Birks Consultant Hand Surgeon GP Education event 1st March 2012

  2. Immediate Complications • Bleeding • Apply direct pressure • Elevate the hand • If not stopped after 20-30min contact the Sheffield Hand Centre (SHC), Surgical Assessment Centre or Emergency Department

  3. Early Complications • Infection • Unusual • If metalwork in situ refer back to SHC • If soft tissue procedure then treat empirically with oral antibiotics (staph cover) • If patient unwell refer back to SHC or Emergency Department

  4. Early Complications • Wound dehiscence • Redress the wound • Refer back to SHC for assessment • Depending on time since procedure, site, surgery and patient factors the wound may be sutured or left to heal by secondary intention

  5. Short to Medium Term Complications • Swelling • Elevate the hand • Move the fingers as much as the post operative instructions allow • Consider referral back to SHC for hand therapy (pressure garments & other modalities)

  6. Medium Term Complications • Stiffness (Assuming no post operative restrictions) • Encourage active and passive movement of the fingers, thumb and wrist • Consider referral back to SHC for hand therapy as this can be very beneficial

  7. Medium to Long Term Complications • Complex Regional Pain Syndrome (CRPS) • Also known as Reflex Sympathetic Dystrophy (RSD), Sudek’s Atrophy and Allodynia • Difficult and poorly understood • Best prognosis is from prompt diagnosis and hand therapy

  8. Medium to Long Term Complications • CRPS features • Excessive pain with no other complications • Vasomotor symptoms (sweating, colour change, swelling) • Stiffness • Increased hair/nail growth

  9. Medium to Long Term Complications • CRPS treatment • Comprehensive conventional oral regime • +/- Amitriptyline 5-10mg nocte • Pain Clinic • Hand Therapy (for mirror box therapy, oedema control, mobilisation and rehabilitation)

  10. Any Questions?

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