••• CHAPTER 35^ Postoperative Care of the Gynecologic Patient^355
❍ What is the best way to close a fascial dehiscence?
A mass closure with through-and-through monofilament nylon or a Smead-Jones closure.
❍ What is the most common sign of wound disruption?
Spontaneous serosanguinous fluid from the abdominal incision.
❍ When diffuse erythema surrounds a wound infection within the first 24 hours postoperatively, what is the
most likely etiology?
Beta-hemolytic streptococci, needing prompt intravenous antibiotics.
❍ How should granulation tissue at the vaginal vault apex following hysterectomy be treated?
Chemical cautery, cryocautery, or electrocautery.
❍ In operative cases where the risk of wound infection is high, what measure can be used to decrease the risk?
Delayed primary closure of the wound decreases wound infections from 23% to 2%.
❍ Where do rectovaginal fistulas usually occur following gynecological surgery?
After hysterectomy, the fistula occurs in the upper third of the vagina; after a posterior repair, the fistula is usually
in the lower third of the vagina.
❍ When do the majority of rectovaginal fistulas present in the postoperative period?
7 to 14 days postoperatively.
❍ How is a prolapsed fallopian tube diagnosed?
Watery discharge, postcoital spotting, coital pain, or lower abdominal pain within the first few months following
hysterectomy. On speculum examination, a portion of tube may be visible at the vaginal apex.
❍ In what situations are suprapubic catheters useful?
When prolonged drainage of the bladder is anticipated such as after a radical hysterectomy.
❍ What is the treatment of ARDS?
Treatment of the underlying etiology, ventilatory support and PEEP, and careful fluid management.
❍ What is the treatment of cardiogenic pulmonary edema?
Assessment of volume status and cardiac ischemia, oxygen, diuretics, and afterload reduction.
❍ What are the postoperative pulmonary changes that predispose patients to atelectasis?
Decrease in vital capacity and functional residual capacity, discomfort from sighing and deep breathing, and
impairment of the mucociliary clearing mechanism.
❍ What is the most common postoperative complication in patients with mitral stenosis?
Pulmonary edema due to excess fluid administration.