1) Primary intention is used if wound margins can be approximated

together. Common ways of achieving closure of wound edges include

adhesive strips, sutures, grafts, flaps or superglue. From day 1-4,
where the fibrin clot is formed at wound site, neutrophils and
macrophages release cytokines which promotes phagocytosis of
bacteria, followed by the process of granulation tissue formation. At
day 5, collagen fibrils aid to bridge the wound incision. Wound closure
is expected with sufficient tensile strength to remove the sutures after
7-10 days, and to regain 80% tensile strength after 3 months. A
reduced wound opening minimizes microbiological contamination,
leading to minimal scar formation and cosmetically pleasing recovery.
Potential problems with primary intention is foreign material
contamination, leading to tissue damage and abscess formation. When
decontamination of wound is difficult, and immediate closure
unadvisable, secondary intention will be used.
2) Local factors include tumour, infection and desiccation. Tumour
reduces blood flow and impedes healing. Infection from bacterial
colonization prolongs the inflammatory process, disturb clotting
cascades and promote disordered leukocyte formation. Desiccation
must be prevented as a moist environment is favorable for
epithelialization, and prevents crust formation over the wound site.
Other local factors are tissue type, oedema, trauma and wound size.
Systematic factors include malnutrition, vascular insufficiency, age
and chronic disease. Foods high in protein, iron, minerals (zinc and
copper) and vitamins promoteswound recovery. A decrease in
vascularity can cause ulcers due to decreased blood supply. Also, the
elderly may experience slower wound recovery from impaired humoral
responses and blood circulation. Chronic diseases such as CVD,
diabetes mellitus and cancer may also compromise the bodys
immunity.
3) One complication developed by the patient is ILEUS, a temporary
absence of normal contractile movements, or non-mechanical blockage
of the intestinal wall. This may have been caused by patients
proctectomy, which may have lead to bloating, constipation and loss of
appetite, as experienced by the patient. Ileus commonly occurs for 2472 hours after abdominal surgery, particularly when the intestines
have been manipulated. Drugs administered to patient following
surgery may also have cause ileus.
Another complication faced is STOMA infection. A stoma is a
surgically created opening on the abdomen which allows waste to exit
the body. The patient experienced skin irritation complaints around the
opening of the stoma and stoma bag, caused by contact with feces.
This can cause formation of necrotic tissue which promotes bacterial
aggregation on the superficial wound surface

4) Ileus is treated by refraining from eating (patient stopped eating for

10 days following surgery). Patient is given Intravenous drips and
electrolytes to keep hydrated. He might be given pills (laxatives),
suppositories, or enemas to activate bowel movements. The buildup of
gas and liquid in the intestines can be relieved by passing a tube is
through the nose or anus into the stomach or small intestine
respectively, with suction applied to relieve pressure.
Keeping the skin surrounding stoma clean is important to prevent
bacterial colonization, particularly from feces. Patients wound dressing
is changed daily for necrotic tissue to slough away. Antiseptics are also
applied to prevent infection.