1st Exam. Part 9. WOUND Flashcards
Any break or discontinuity in layers of skin or tissue of organ
wound
(2) Closed wounds
- Contusion
- Abrasion
(4) Open wound
- Laceration
- Puncture
- Penetrating
- Avulsion
unbroken skin, caused by crushing of underlying tissue
closed wound
damaged soft tissues without breaks in skin, trauma is caused by blunt force trauma
(bleeding is more observed in this type of wound)
Contusion
break in the skin that involves the dermis, trauma is caused by scraping or friction (ALT)
Animal continuously licks the paws that results in _____
Abrasions
skin is penetrated or broken
Open wound
slender or straight cut cause by sharp objects
clean edges
Incision
irregular edges and tearing of skin and underlying tissues;
torn wound edges
Laceration
caused by pointed objects;
deep
Puncture
body cavities are affected at a deeper level
Penetrating
partially and fully torn skin that tends to bleed a lot and causes great trauma
Avulsion
wounds that are located in the limbs
degloving wounds
Phases of wound healing (3)
- Inflammatory
- Proliferation
- Remodeling
- Occurs within minutes after initial wound
- Starts with vasoconstriction then vasodilation
- Wound is rinsed and filled with blood-collagen and fibrin constituents
- Cytokines are produced in this stage
- Scab formation (platelets)
- Active bleeding of the wound
- Clot formation
- Scab formation
INFLAMMATORY phase
occurs 3-5 days after initial injury
- Epithelium regulates collagen fiber
- Migration of collagen, fibroblasts and the like
- Fibrin network : scaffold for wound, support for collagen, attracts more platelets
- “ Itchy phase“
- Re-epithelialization
- Resorption of blood collagen
- Angiogenesis occurs
- Epithelial proliferation and migration
- Longest phase
- Wound contraction : wound is smaller due to re-epthilialization, centripetal movement of epithelial cells
PROLIFERATION phase
- Growth of new epithelial cells
- Reorganization of collagen to provide a sturdier support
- 14-21 days of remodeling
- Tissue layers are not as strong as original tissue
[ Scar matures > Wound strengthens > Complete
Healing & __________ ]
REMODELING phase
Duration of wound healing may depend on (4)
- Wound type
- Wound mgt.
- Microbiological factors
- Physiological factors
_______ may be used for wound management
General anesthesia
- Initial Management
- Debridement
- Suturing
- Bandaging (+/- Drainage)
- Antiseptics/Antibiotics
Wound management
- Stabilize the patient
- Physical examination
- Wash, clip and shave
- Removal of gross debris
Initial management
- Removal of foreign material, necrotic, damaged or if infected tissues such as wound edges
Debridement
For cases of _______, wound edges should be as clean as possible so healing and apposition could occur as clean as possible
laceration
(3) types of Debridement
[ SEM ]
- Surgical
- Enzymatic
- Mechanical
debridement that uses sharp scissors or scalpel
require anesthesia
Surgical
Debridement that selectively removes non viable
tissues, fine debridement,
Indicated in patients with
increases anesthesia patients (trypsin and chymotrypsin)
Enzymatic
uses adherent bandages, contaminated tissue remains even after surgery
Mechanical
Following _____ and _____, decide whether to close wounds by sutures or not
excision and debridement
(3) Categories of Wound Healing
- First intention / Primary wound closure
- Second intention / Secondary wound closure
- Third intention / Tertiary wound closure
Stitch wound that is already debrided (minor wound or
surgery)
Use of surgical stapler non absorbable or absorbable suture materials
First intention / Primary wound closure
Performed mainly for wounds located at limbs (avulsion);
Used for skin with much tension
Simple bandaging but no surgical procedures or suturing
Intervention of wound by medical approach
Longer time for wound to heal
Second intention / Secondary wound closure
re-epithelialization first before wound closure
Third intention / Tertiary wound closure
- It is important to know the size and type of suture
material
Suturing
What kind of suture should be used in SKIN?
Non-absorbable sutures
What kind of suture should be used in INTERNAL ORGANS
Absorbable sutures
Suture:
The higher the number = the ____ the diameter
smaller
infection could be more common in this type of suture
Monofilament / Multifilament
- Reduce or eliminate the dead space;
- Protects wound from external trauma and bacteria
- Absorbs secretion such as EXUDATE (allow characterize the lesion); should press against dead space;
- Decreases edema and hemorrhage ; immobilizes wound and promote healing;
- Vehicle for antibiotics and antiseptics ; should be applied not too loosely or tight
Bandaging
exit point for blood, pus or serum accumulation
Drainage
uses gravity or capillary action
Passive drainage
____ rubber causes additional inflammation
Latex
vacuum, uses NEGATIVE pressure
Active drainage
- Container switch vacuum
- Drainage is faster
- Extra apparatus is required which results to discomfort
Active drainage
