9 - Wounds

Question 1

Closure types

Answer 1

Primary intent
- sutures (w/in 8-24hrs)
Secondary intent
- pack and let heal on its own
Tertiary intent
- delayed primary closure

Question 2

Contusions?

Answer 2

Bruises
- intact skin

No surgery or tetanus or anything

Question 3

Abrasion

Answer 3

Superficial inj to epidermis a superficial dermis

• tetanus
• abx (maybe)

Question 4

Punctures

Answer 4

Deeper than wide (usually)

• dont explore these
• heal by secondary intent

Question 5

Laceration

Answer 5

Injury through dermis to SQ tissue

• primary closure
• close w/in 6-8hrs

If infected can use 2ndary intent

Question 6

Crush injury

Answer 6

US or MRI to evaluate extend of deeper wounds

Can lead to compartment syndrome

Question 7

Signs of compartment syndrome?

Answer 7

Pain out of proportion
Intracompartment pressure >30

Tx w Fasciotomy
Monitor UOP
Serial CK/CMP

Question 8

Extravasation?

Answer 8

Infiltration of caustic substance from IV infusion

Question 9

Highly caustic substances (extravasation) may need?

Answer 9

Debridement
Inj of antidote
Aspiration

Grafting

Question 10

Bites

Answer 10

Human 
- serious joint infection
Spiders
- brown recluse (cellulitis w sloughing)
- may need skin graft
Snakes
- elapids (cobras/mambas)
- vipers (rattle snakes etc)

Question 11

Elapids cause?

Answer 11

Neurotoxic venum

• tremors, myalgias
• cardiac and pulm manifestations

Question 12

Vipers cause?

Answer 12

Cytotoxic venom

• tissue necrosis
• hemolyiss
• compartment syndrome -> fasciotomy

Question 13

High velocity wounds?

Answer 13

Gunshots, explosions

• high kinetic inj
• small entrance wound (deceiving)

Question 14

Surg indications for high velocity wounds?

Answer 14

• ID underlying tissue
  Vessels or organ injury
• explore depth, debride and clean
• remove projectile

Question 15

Amputation can be managed?

Answer 15

Limb salvage

• extensive surg
• yrs of PT and surgeries

Amputation

• often pts prefer this (faster healing etc)
• better functional outcomes if joint is preserved

Question 16

Wound management overview?

Answer 16

Wear gloves
Sterilized site
Anesthetize area
Copious irrigation
Wound closure
- based on wound type
Update tetanus

Question 17

What is granulation healing?

Answer 17

Normal healing process

- hyper-granulation can be attenuated w silver nitrate

Question 18

Wounds closed ___ ___ heal better

Answer 18

Without tension

Question 19

How to decrease tension to close wound?

Answer 19

Undermine tissue if needed

• elevate skin
• dissect skin
• clean edges
• only undermine as much as needed
• leave some open if needed
• can clsoe w DPC or secondary intent, w or w/o skin graft

Question 20

A wound vac is an example of?

Answer 20

Negative pressure wound dressing (NPWD)

Slide 17 if you want to see it

Question 21

Goal of copious irrigation?

Answer 21

Dilute bacteria into extinction

Question 22

What to do with a surgical site infection?

Answer 22

Investigate and irrigate/debride
- may use NPWD

manage w packing

• gauze
• moist or dry
• cover
• change daily

Question 23

Wound management of a narrow (puncture) wound

Answer 23

Heal w secondary intent

• insert gauze or packing into wound
• leave tail to retrieve and replace
• cover
• change daily

Question 24

My wedding was so beautiful

Answer 24

Even the cake was in tiers