What is sinus and fistula? Fistula is an abnormal communication between the lumen of one viscus to another or the body surface or between the vessels. Congenital: Pre-auricular sinus. Acquired: Actinomycosis, tuberculosis, pilonidal sinus, chronic osteomyelitis, median mental sinus. What is fistula? Sinus is a blind track lined by granulation tissue leading from an epithelial surface into the surrounding tissues. Surgical site infection Infection within 1 month of surgery or 3 month of implant What are the types of surgical site infection? National Nosocomial Infections Surveillance System (NNIS) describes three types of surgical site infections: Superficial incisional SSI - It occurs within 30 days after the operation. It involves only the skin or subcutaneous tissue. It is diagnosed by at least one of the following a) Purulent drainage is present (culture documentation is not required). b) Organisms are isolated from fluid/tissure of superficial incision. c) At least one sign of inflammation (pain, induration, erythema, local warmth or the wound) is present d) The surgeon or clinician declares the wound to be infected.  Deep incisional SSI - Occurs within 30 days of operation or within 1 year if an implant is present. It involves deep soft tissues (e.g fascia and/or muscle) of incision. It includes at least one of the following  - Purulent drainage is present from the deep incision but without organ/space involvent.  - Fascial dehiscence or fascia is deliberately separated by the surgeon because of signs of inflammation.  - A deep abscess is identified by direct examination or during reoperation, by histopathology or by radiologic examination.  - The surgeon or clinician declares that a deep incisional infection is present.  Organ/space SSI - Occurs within 30 days of the operation or within 1 year if any implant is present. It involves anatomical structures not opened or manipulated during the operation. It should include at least one of the following  - Purulent drainage is present from a drain placed by a stab wound into the organ/space.  - Organisms are isolated from the organ/space by aseptic culturing technique - An abscess in the organ/space is identified by direct examination, during reoperation or by histopathologic or radiologic examination.  - A diagnosis of organ/space SSI is made by the surgeon or clinician. Wound healing Delayed wound healing if it takes >1month in general History taking Do not say name in history taking What is palliative care? Palliative care is care provided for people living with, and dying from an eventually fatal condition to - to improve quality of life  - it is not only provided to patient but also to patient party  - provided after diagnosis or even after death ???  Terminal ill patients like HIV, cardiac diseases, CKD Removal of suture Head and face at 5 days Upper limb at 7 days Abdomen and lower limb at 10 days What is Jenkin's Rule? Jenkin's Rule is a principle of surgery relating to closure of surgical wounds. It states that the required length of the surgical suture material for closure of a wound with interrupted stitches is four times the length of the wound, as each bite should be 1 cm from the edge, and placed 1 cm from the previous suture.