Postoperative Management

The wound should be inspected daily, and the surgeon should have a low threshold for redebridement. A mean of 2.5 debridements per patient is reported in the literature (Baskin et al. 1990; Corman et al. 1999). Bacterial culture results should be checked to make sure that appropriate antibiotic therapy is given. If the patient is in renal failure, aminoglycosides should be avoided and a third- or fourth-generation cephalosporin should be given.

Nosocomial infections should be prevented as far as possible. Pulmonary complications (e.g., atelectasis) should be prevented. If postoperative fever persists or the patient does not improve clinically, a persistent source of infection should be suspected. CT or MR imaging may demonstrate an intraabdominal or retroperitoneal infective cause. However, even if these studies are negative, there should be a low threshold for reexploration and redebridement of the patient under anesthesia.

Maintaining a blood glucose level of 4-6 mmol/l (74-110 mg/dl) optimizes cellular immunity and reduces morbidity and mortality in the septic patient, regardless of whether there was preexisting diabetes or not (Van den Berghe et al. 2001; Fourie 2003).

In the acutely ill patient, the development of ileus, stress ulcers, and translocation of gut flora are common complications. Stress ulcers can be prevented by giving sucralfate (1 gevery6-8h). Gut integrity can be maintained by starting early with gastrointestinal feeding and by using enteral rather than parenteral nutrition (Anderson and Vaslef 1997). The caloric needs of 25-35 kcal/kg per day and protein of 1.5-2 g/kg per day should be met, especially in patients with large wounds, malnutrition, and those on ventilation (Baskin et al. 1990; Anderson and Vaslef 1997).

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