2 Wound Preparation

Question 1

Wound preparation is aimed at

Answer 1

reducing the risk of infection,
optimizing cosmetic outcome,
and minimizing patient pain and discomfort

Question 2

In general, wound preparation starts with

Answer 2

decontamination of the skin surrounding the laceration, followed by local anesthesia through the wound edges

Question 3

Components of wound preparation

Answer 3

1. Skin disinfection
2. Wound anesthesia
3. Hair removal
4. Control of bleeding
5. Wound irrigation
6. Wound debridement
7. Removal of foreign bodies

Question 4

TRUE or FALSE
Use of sterile gloves for laceration repair or outpatient surgical procedures does not reduce infection rates compared to clean, nonsterile gloves

Answer 4

TRUE
also, full sterile technique (mask, cap, gown, and gloves) apparently does not reduce wound infection rates after laceration repair in the ED setting

Question 5

Agents used for skin disinfection

Answer 5

Povidone-iodine
Chlorhexidine (likely a better agent)

Regardless of which agent is used, avoid contact of the antiseptic agent with the wound or the eyes.
The antiseptic should be allowed to dry for 2-3 minutes for maximal efficacy

Question 6

gelatin vs cellulose vs collagen in terms of controlling bleeding

Answer 6

gelatin works by the pressure it exerts as it expands

cellulose and collagen reacts with blood, forming an artificial clot

Question 7

how to apply topical tranexmic acid

Answer 7

saturate a gauze pad with the liquid tranexamic acid (5 to 10 mL of the 100mg/mL solution),
or it can be applied as a powder (created by crushing tranexamic acid tablets) or a paste (created by mixing about 2000 mg of crushed tranexamic acid with 2 mL of sterile water)

the material is left on for 20-to 30 minute, then removed so wound closure can proceed

Question 8

This suture techniques can be done when simple interrupted sutures do not control bleeding from wound edges

Answer 8

either a horizontal mattress suture or a figure-of-eight suture

Question 9

in scalp lacerations, the sutures should include the underlying

Answer 9

galea aponeurotica, since most bleeding vessels are within this layer

Question 10

high-pressure irrigation should be limited only to

Answer 10

heavily contaminated wounds

50 to 100mL per cm of contaminated wound

Question 11

high pressure in irrigation is defined as

Answer 11

> 7 pounds per square inch (psi) or 48 kPa

Do NOT use high pressure when irrigating areas with loose areolar tissue such as the eyelids

Question 12

TRUE or FALSE
tap water is as effective as normal saline in reducing wound infections in both children and adult with traumatic lacerations

Answer 12

TRUE

Question 13

For wounds that cross the relaxed skin tension lines (aka lines of minimal tension) at an angle greater than 30 degrees, this technique can improve cosmetic outcomes

Answer 13

W-plasty