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SURGERY <3 > 2. Wounds and it's management > Flashcards

2. Wounds and it's management Flashcards

1
Q

Define a wound.

A

A wound is a tissue defect characterised by a breach in the continuity of the skin and it’s deep tissue, which is secondary to an injury, in which the deeper tissues (Fat, Muscle, Bone or Vessels) may or may not be injured.

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2
Q

How do you classify different wounds?

A
  1. Duration
  2. Closed/Open Wound
  3. Simple/Complex Wound
  4. Contamination of Wound
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3
Q

Classify wounds according to their duration.

A
  1. Acute (< 6 weeks)

2. Chronic (> 6 weeks)

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4
Q

State 2 types of Closed wounds.

A
  1. Contusion

2. Haematoma

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5
Q

State 4 types of Open wounds.

A
  1. Abrasions
  2. Incised wounds
  3. Lacerated wounds
  4. Crushed wounds
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6
Q

State 4 types of wounds based on their contamination.

A
  1. Clean wound
  2. Clean contaminated wound
  3. Contaminated wound
  4. Dirty wound
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7
Q

Give an example of a Clean wound.

A

An operative wound ex; Thyroidectomy

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8
Q

Give an example of a Clean Contaminated wound.

A

A wound in a Cholecystectomy

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9
Q

Give an example of Contaminated wound.

A

A wound in a Hemicolectomy

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10
Q

Give an example of Dirty wound.

A

A wound in a Laparotomy for a case of peritonitis

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11
Q

State the 3 phases of Wound Healing.

A
  1. Inflammatory Phase
  2. Proliferative Phase
  3. Remodelling (Maturation) Phase
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12
Q

State 5 local factors affecting wound healing.

A
  1. Foreign bodies
  2. Infections
  3. Lack of Rest
  4. Ischaemia
  5. Sutured under tension
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13
Q

State 7 systemic factors affecting wound healing.

A

I A McDAD

  1. Immunocompromised State (Chemo, AIDS)
  2. Anaemia
  3. Malnutrition (Proteins, Vit. C, Zinc)
  4. Co-existing Diseases (Cancer, Liver/Kidney diseases)
  5. Drugs (Steroids)
  6. Age (Old age)
  7. Diabetes Mellitus
  8. Smoking
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14
Q

A wound commonly heals by …… ?

A
  1. Healing with Primary Intention
  2. Healing with Secondary Intention
  3. Healing with Tertiary Intention
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15
Q

Explain Healing with Primary Intention.

A

It is usually seen in clean, incised wounds where the tissue is well-approximated (opposed) and there isn’t major tissue loss. The tissues has to be viable with no tension. It occurs when the wound isn’t infected. Healing w. Primary Intention has minimal scarring and has a best result, functionally and cosmetically.

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16
Q

Explain Healing with Secondary Intention.

A

It is usually seen in crushed, lacerated, devitalised wounds where the tissue is not well-approximated and there is major tissue loss. It usually occurs when the wound is infected. Healing w. Secondary Intention has a lot of scarring and won’t have the best result, functionally and cosmetically.

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17
Q

A patient arrives to the OPD with a wound, what treatment regime do you think is the best?

A
  1. Resusitate the patient, if necessary
  2. Hospitalize the patient
  3. Examine and diagnosis the wound (Site, size and damage structures)
  4. Assess movement and sensations while watching for pain and listening to the patient
  5. Provide a tetanus shot
  6. If the wound is large, book an OR for operative treatment to repair damaged structures
  7. Administer adequate and appropriate anaesthesia
  8. If the limb is injured, apply a tourniquet
  9. Start debridement of the Wound
  10. Apply skin cover if required
  11. Start skin closure (suturing) w/o tension
18
Q

How do you debride a wound?

A
  1. Ensure wound is adequately exposed
  2. Extend the incision, if necessary
  3. Secure bleeders by haemostasis
  4. Start removal of foreign bodies
  5. Excise all dead/devitalized tissues
  6. Excise dead muscles
  7. Tendons and nerves are left alone
  8. Once done, the wound is washed with warm, sterile normal saline solution
19
Q

How do you know if a muscle is dead?

A

Muscle viability is assessed by the colour (pink), bleeding pattern and contractility.

20
Q

How do you know if you’ve removed all the devitalized tissue?

A

The devitalized tissue is excised until bleeding occurs, with the exception of nerves, vessels or tendons.

21
Q

State the 3 types of wound repairs applied in Skin Closure?

A
  1. Primary Suture
  2. Delayed Primary Suture
  3. Secondary Suture
22
Q

When is a Primary Suture done?

A

It is done if patient presents with a wound within 6 hours of being injured and is able to heal with primary intention.

23
Q

When is a Delayed Primary Suture done?

A

It is done if the patient presents with a wound after 6 hours of being injured. The wound is placed under antibiotic cover and left open. This is to ensure there isn’t any infection before closing it. A delayed primary suture is applied after 4-7 days.

24
Q

When is a Secondary Suture done and how?

A

A secondary suture is done when a wound is severely infected

  1. First, start debridement and remove as much pus as possible.
  2. Excise the dead, devitalized tissues
  3. Clean the edges of the wound
  4. Insert drains to drain out the pus
  5. Leave the wound open with dressings
  6. When appropriate, apply suture/skin cover.
25
Q

Which wound infection is very common?

A

Tetanus infection

26
Q

What organism causes Tetanus?

A

Clostridium tetani, a Gram Positive, anaerobic bacilli is responsible for tetanus infections.

27
Q

How do we avoid Tetanus infections in patients?

A

By providing Tetanus prophylaxis

28
Q

State 2 methods of Prophylaxis against Tetanus.

A
  1. Active Immunization

2. Passive Immunization

29
Q

How is Active Immunization against Tetanus provided?

A
  1. Childhood vaccination is given (DPT Vaccine, 3 doses)

2. A booster dose is given when a wound occurs

30
Q

What if the patient was not previously immunized?

A

3 doses of Tetanus Toxoid I.M. Injection is given

  • 1st Dose is given on the day of injury
  • 2nd Dose is given after 6 weeks
  • 3rd Dose is given after 6 months
31
Q

How is Passive Immunization against Tetanus provided?

A

By administering 50 units of Anti-tetanus Globulin I.M. Injection

32
Q

What is a scar made of?

A

A scar is a mark left on the skin/body tissue where a wound, burn, or sore has not healed completely and fibrous connective tissue has developed, predominantly made of collagen tissue.

33
Q

Name the cell which lays the collagen tissue in a healing scar.

A

Fibroblasts

34
Q

What happens when excessive collagen deposition occurs?

A

A Hypertrophic Scar or Keloid is formed

35
Q

What is a Hypertrophic Scar?

A

It is the formation of excessive scar tissue along a skin wound which is elevated and confined to the original wound/incision. It usually stabilizes after 6 months.

36
Q

What are the 3 common sites of Hypertrophic Scars?

A
  1. Anterior Chest Wall
  2. Shoulder region
  3. Deltoid region
37
Q

What is a Keloid?

A

It is the formation of excessive scar tissue along a skin wound which is elevated and can extend beyond the original wound/incision. It continues to grow after 6 months.

38
Q

A Keloid is commonly seen in …….. ?

A

Dark-skinned people (Africans)

39
Q

Is a Keloid a tumour?

A

No

40
Q

State 3 ways to treat a patient with a Keloid?

A
  1. Pressure dressing
  2. Intra-lesional Steroid Injections
  3. Cryotherapy

SURGERY <3 (2 decks)

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