3: Wound healing Flashcards
<p>What are the phases of wound healing?
| Roughly when do they occur?</p>
<p>Hemostasis: immediate
Inflammation: days 0-7
Proliferation: days 4-21
Remodeling: 3 weeks to 6-12 months</p>
<p>What common class of medications interfere with wound healing?</p>
<p>Glucocorticoids
| (Others: Some chemotherapeutic and immunosuppresant drugs, angiogenesis inhibitors)</p>
<p>What is the most important step in treating wound infections?</p>
<p>Source control</p>
<p>What are healing by primary, secondary, and tertiary intention?</p>
<p>Primary intention: directly approximating wound edges
Secondary intention: allow granulation and contraction to close wound
Tertiary: allow wound to begin to heal open, but then close as in primary intention</p>
<p>What is the downside of secondary intention healing?</p>
<p>Slower healing, more scar, more contraction.</p>
<p>What are some key medical problems that impair wound healing? (8)</p>
<p>Malnutrition Immunosuppression Ischemia Physiologic stress Uremia Obesity Diabetes Smoking</p>
<p>What is the likely diagnosis if a healed wound (3 months old) has a small sore red area that intermittently drains a small amount of pus, then seals over?</p>
<p>Stitch abscess. Removing the stitch generally fixes it.</p>
<p>How long do wound remodeling and maturation continue to occur?</p>
<p>At least 6 months after the wound</p>
<p>What is the mainstay of treatment for a local wound infection?</p>
<p>Drain wound completely and debride any nonviable tissue.</p>
<p>What is the role of antibiotics in wound infection?</p>
<p>Many wound infections do not require systemic antibiotics. However, they are necessary if there is spreading cellulitis despite wound drainage.</p>
<p>What are the surgical wound classes (in terms of cleanliness)?</p>
<p><strong>Clean</strong>: No inflammation/infection encountered, no entry into respiratory, GI, genital, or urinary tracts.</p>
<p><strong>Clean-contaminated</strong>: No inflammation/infection encountered, but is entry into one of those tracts.</p>
<p><strong>Contaminated</strong>: Accidental wounds, breaks in sterile technique, gross spillage from GI tract, involvement of acute nonpurulent inflammation.</p>
<p><strong>Dirty</strong>: Retained devitalized tissue, existing infection, perforated viscera, old traumatic wounds with devitalized tissue.</p>
For what types of procedures are perioperative antibiotics indicated?
Not indicated if they are clean and involve implantation of no foreign body, unless there is immunosuppression or poor blood spply.
Required for all clean-contaminated and higher, and if foreign body implanted.
When should perioperative antibiotics be given?
Within an hour of incision
