Post-Operative Edema1

1. Dr. Bahaa Ali Kornah Prof.. Of Orthopedic Al-Azhar University Cairo – Egypt Post-Operative Edema bahaa Ali Kornah - Al-Azhar Un.-Cairo. EGYPT

2. Post-Operative Edema Definition, Causes, Management

3. What Is Edema?What Causes Edema?Is Swelling Normal After Surgery?What Affects Edema After Surgery?How Do You Manage Edema After Surgery?How Long Does Post-Op Edema Last?What Symptoms Can You Expect After Surgery?The Bottom Line: Managing Edema After Surgery bahaa Ali Kornah - Al-Azhar Un.-Cairo. EGYPT

4.  Definition • Edema: The abnormal accumulation of fluid in the interstitial spaces (tissues) outside of the blood vessels. • Post-Operative Edema: Swelling that occurs at or near a surgical site as a result of the trauma induced during a procedure. bahaa Ali Kornah - Al-Azhar Un.-Cairo. EGYPT

5. Filtration = Reabsorption + Lymphatic Flow small net filtration (typically about 1% of plasma) of fluid from the intravascular to the extravascular compartment. Capillary fluid filtration exceeds reabsorption. bahaa Ali Kornah - Al-Azhar Un.-Cairo. EGYPT

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7. Pathophysiology: Why Does It Happen? • Surgical trauma → inflammation → ↑ capillary permeability • Fluid leakage into interstitial space • Reduced mobility → venous stasis • Lymphatic overload

8. Pathophysiology: Why Does It Happen? • Title: The Body's Inflammatory Response • 1. Surgical Trauma: Incision, cutting, manipulation damages cells and blood vessels. • 2. Inflammatory Cascade: The body releases histamine, cytokines, and other mediators. • 3. Increased Capillary Permeability: These mediators cause small blood vessels (capillaries) to become "leaky." bahaa Ali Kornah - Al-Azhar Un.-Cairo. EGYPT

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10. Pathophysiology: Why Does It Happen? • Title: The Shift of Fluids • 4. Fluid Shift: Plasma proteins (especially albumin) leak into the interstitial space. • 5. Osmotic Pressure: These proteins draw water out of the capillaries into the tissues, causing swelling (edema). • Lymphatic Disruption: Surgery can temporarily impair lymphatic vessels that normally drain excess fluid, contributing to accumulation. • . bahaa Ali Kornah - Al-Azhar Un.-Cairo. EGYPT

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12. Risk Factors •  Who is at Higher Risk? • Procedure-Related: • Lengthy operations • Extensive tissue dissection • Operations in areas with rich blood supply (e.g., head, neck, genitals) • Patient-Related: • Pre-existing venous insufficiency or lymphedema • Heart, kidney, or liver disease • Poor nutritional status (low protein) • Use of medications like corticosteroids, calcium channel blockers • Obesity bahaa Ali Kornah - Al-Azhar Un.-Cairo. EGYPT

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14. Causes of Post-Operative Edema • Physiological: • tissue injury, inflammation • Mechanical: • immobility, tight dressings, tourniquet use • Systemic: • heart failure, renal/hepatic dysfunction, hypoalbuminemia • Complications: • DVT, infection, compartment syndrome

15.  Clinical Features (Signs & Symptoms) •  Recognizing Post-Operative Edema • Visible Swelling: The surgical site appears puffy or enlarged. • Taut, Shiny Skin: Skin stretched over the swollen area. • Pitting Edema: When pressed firmly with a finger, an indentation remains for a few seconds. (Include a photo if possible). • Stiffness & Reduced Range of Motion: Especially with edema near joints. • Feelings of Pressure, Heaviness, or Discomfort. (Pain is usually mild unless severe). bahaa Ali Kornah - Al-Azhar Un.-Cairo. EGYPT

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17. Normal vs. Complicated Edema •  When to Worry bahaa Ali Kornah - Al-Azhar Un.-Cairo. EGYPT

18. Evaluation • History & examination • Monitoring limb girth & swelling progression • Duplex ultrasound (exclude DVT) • Lab tests (renal, hepatic function, albumin) if systemic suspicion

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20. Management • General: limb elevation, early mobilization, physiotherapy • Local care: ice packs, compression, appropriate wound care • Pharmacological: analgesics, anti-inflammatory agents, diuretics (if systemic cause) • Specific: anticoagulation if DVT, fasciotomy if compartment syndrome

21. Management Strategies (The RICE Principle) •  First-Line Management: R.I.C.E. • R - Rest: Avoid strenuous activity that increases blood flow to the area. • I - Ice: Apply cold packs (wrapped in a towel) for 15-20 minutes several times a day. Causes vasoconstriction, reducing blood flow and swelling. • C - Compression: Use elastic bandages or compression garments as prescribed. Prevents fluid accumulation. • E - Elevation: Keep the affected limb/area above the level of the heart. Gravity assists venous and lymphatic drainage. bahaa Ali Kornah - Al-Azhar Un.-Cairo. EGYPT

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23. Medical and Pharmacological Management • Title: Beyond RICE • Diuretics: (e.g., Furosemide) Used cautiously and short-term for severe edema; not routine. • NSAIDs: (e.g., Ibuprofen, Naproxen) Reduce inflammation and provide analgesia. • Serratiopeptidase/Enzymes: Used in some countries to reduce inflammation and swelling. • Physiotherapy: Manual lymphatic drainage (MLD) massage, specialized exercises. • Nutrition: Adequate protein intake is crucial for maintaining oncotic pressure and healing. bahaa Ali Kornah - Al-Azhar Un.-Cairo. EGYPT

24. Pharmacological Treatment of Postoperative Edema • NSAIDs reduce inflammation and swelling (ibuprofen, diclofenac, celecoxib). • Corticosteroids may be used short-term in selected severe inflammatory cases. • Venoactive drugs (diosmin–hesperidin, escin, troxerutin) improve venous and lymphatic drainage. • Diuretics have limited role; reserved for systemic fluid overload. • Enzyme therapy (e.g., serratiopeptidase) sometimes used as adjunct. • Medication must accompany elevation, compression, and early mobilization.

25.  Patient Education & Prevention •  Empowering the Patient • Pre-operatively: Optimize health (manage weight, chronic conditions). • Understand and adhere to the RICE protocol, especially elevation. • Keep compression garments on as directed. • Attend all follow-up appointments. • Maintain a balanced diet rich in protein. • Stay hydrated unless contraindicated. bahaa Ali Kornah - Al-Azhar Un.-Cairo. EGYPT

26. Red Flags: When to Call the Surgeon  Seek Immediate Medical Attention If You Experience: Sudden, massive increase in swelling. • Severe pain not relieved by medication. • Signs of infection: Fever (>101.5°F), redness, warmth, pus. • Color changes: Blue, purple, or white discoloration of the skin. • Chest pain or shortness of breath (could indicate DVT/PE). • Loss of sensation or function in the limb. bahaa Ali Kornah - Al-Azhar Un.-Cairo. EGYPT

27. Prevention • Adequate intraoperative positioning • Avoid prolonged tourniquet time • Early mobilization post-op • Proper fluid balance • Compression garments when indicated

28. Complications if Untreated • Delayed wound healing • Risk of infection • Thrombosis • Chronic lymphedema • Functional limitation

29. Conclusion • Post-op edema is common but usually self-limiting • Requires careful monitoring to rule out complications • Prevention and early management improve outcomes • Management is centered on the RICE principle. • Patient education is critical for proper management and monitoring. • Recognize the signs of complication (infection, DVT) and act promptly.

30. Good Luck and Thank You for Your Attention Bahaa Kornah بهاء قرنة Bahaa Ali kornah -Alazhar Un. Cairo.Egypt