Prevention and Management of Surgical Site Infections in Morbidly Obese Women

摘要

CASE: A 42-year-old primiparous woman presented with a growing abdominal mass and pain. She had no prior surgical history and took medication only for asthma. She was 162 cm tall and weighed 115 kg (body mass index 43.7). A CT scan demonstrated a 34-cm complex abdominal mass and a 12-cm ventral hernia.In the operating room, she received 2 g of cefazolin before a vertical skin incision was made with a scalpel. The subcutaneous tissue was incised with electrocautery. Abdominal entry required dissecting more than 10 cm of subcutaneous tissue and ligating large blood vessels within the fat. Operative findings included 1 L of ascites, a large left ovarian mass extending to the liver edge, normal right adnexa, and a 14-week sized leiomyomatous uterus. Total hysterectomy, bilateral salpihgo-oophorectomy, and staging were done. The ventral hernia sac was resected and fascial edges were reap-proximated primarily and without tension with continuous loop delayed absorbable suture. The defects left by the hernia sac and the subcutaneous tissues were closed with three layers of 2-0 plain suture. The skin was closed with staples. The surgery lasted 4.5 hours. Estimated blood loss was 300 mL#