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Surgery > Basic Principles in Wound Care > Flashcards

Basic Principles in Wound Care Flashcards

1
Q

What are the 9 classification of wounds accdg to nature?

A

Abrasion
Incision
Surgical wound
Laceration
Open
Septic
Contusion
Penetration
Puncture

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2
Q

What classification of wound has a tear or disruptive stretching tissue caused by the application of force by a blunt object?

A

Laceration

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3
Q

What classification of wound has tissues exposed to air?

A

Open wound

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4
Q

What classification of wound has either a bedsore or pressur ulcer where wound has become infected?

A

Septicw wound

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5
Q

What classification of wound has bruises produced by a blunt object that damages blood vessels?

A

Contusion

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6
Q

What classification of wound has an object piercing through the skin & enters the body tissue?

A

Penetrating wound

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7
Q

What classification of wound is caused by an object piercing through the skin and enters body tissue?

A

Penetration

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8
Q

What classification of wound does not bleed a lot and can close by itself?

A

Puncture wound

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9
Q

What classification of wound is formed from an object piercing through the skin and enters the body tissue?

A

Penetrating wound

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10
Q

What are the classes of wound?

A

Class I = clean, you can close the wound, no break in aseptic technique

Class II = clean contaminated, good debridement is needed when you cut the skin

Class III = contaminated; from traumatic injuries

Class IV = dirty and infected wounds, abscesses

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11
Q

What are the 3 categories of wound healing?

A

Primary closure
Secondary closure
Tertiary closure

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12
Q

What category of wound healing is accomplished by the wound with sturures at the time of presentation to the ER?

A

Primary closure

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13
Q

What category of wound healing has a wound that is left to heal on its own potentially causing contamination?

A

Secondary closure

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14
Q

What category of wound healing is manifested by wounds that are heavilty contaminated? (Sepsis, peritonitis, etc)

A

Tertiary closure

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15
Q

What are the 3 phases of wound healing?
Clue: IPR

A

Inflammatory phase
Proliferative phase
Remodeling or mature phase

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16
Q

What are the 2 things in which wound healing process depends on?

A

Type of tissue that has been damaged
Nature of tissue disruption

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17
Q

What is the first response to tissue damage? What are the processes that happen within it?

A

Inflammatory phase
- Bleeding
- Coagulation
- platelet activation
- complement activation
- phagocytosis, etc

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18
Q

When does proliferative phase occur and what does it do?

A

Day 4-21

Reparative phases of wound healing

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19
Q

When does epithelialization occur after injury?

A

Within 24-48hrs

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20
Q

What is a hallmark of proliferative phase?

A

Formation of granulation tissue in the wound
= fibroblasts, macrophages, endothelial cells

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21
Q

What is the longest part of wound healing that lasts for 21 days to 1 year?

A

Remodeling or Maturation phase

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22
Q

What is a hallmark of the remodeling phase?

A

Wound contraction & Collagen remodeling

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23
Q

What is the cell responsible for contraction in maturation phase?

A

Myofibroblat

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24
Q

What is mechanical debridement?

A

Used to remove necrotic material by washing or sharp dissection —> scar will occur if not done

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25
Q

What procedure is done visualize all areas of the wound and remove foreign material during wound care?

A

Physiologic saline irrigation

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26
Q

What type of saline is used to clean the wound?

A

NSS w/o additive

10cc syringe + sterile NSS -> jet stream flushing

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27
Q

What is the difference betw Ischemic wounds & well-vascularized wounds?

A

Ischemic wounds: heals very poorly & becomes infected
Well-vascularized: heals very well

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28
Q

What are the 3 types of suturing techniques?

A

Interrupted
Continuous
Subcuticular

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29
Q

What is the most common suturing technique?

A

Interrupted

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30
Q

What are important prerequisites to avoid complicated healing?

A

Meticulous hemostasis
Atraumatic handling of tussues
Avoidance of dead space

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31
Q

When should sutures be removed in the neck & face + extremities & trunk?

A

Neck & Face: 3-5 days
Extermities & Trunk: 7-10 days

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32
Q

What is the % of regained tensile strength in skin, tendon, and fascia after suture?

A

~70-80%

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33
Q

What can happen in re-sutured wounds where non-debridement of wounds edges will accelerate wound healing due to already active fibroblat?

A

Secondary wound phenomenon

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34
Q

What can happen to re-sutured wound that has too much pressure applied on the knot & late removal of skin suture?

A

Railrod track scar configuration

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35
Q

Can epithlization’s process be enhanced in moist environment? How so?

A

Yes.
Saline or emollient dressing can enhance the process

36
Q

What vitamin is given to reverse the inhibitory effect of steroids on epithelization?

A

Topical vitamin A

37
Q

What process occurs when open wounds shrink due to myofibroblasts contraction?

A

Wound contraction

38
Q

What region of the body hsa the gastes wound contraction rate?

A

Face

39
Q

What is the most important aspect in sound healing?

A

Nutrition

40
Q

When protein is depleted, what can happen to wound healing?

A

Fibroplasia & Collagen synthesis can be inhiibited

41
Q

What vitamin deficiency causes pellagra (scaly sores, mucosal changes, a& mental symptoms)?

A

Vitamin B def (Niacin/vit B3)

42
Q

WHat vit deficiency modifies inflam rxn by leading the defect in wound healing like collagen synthesis?

A

Vitamin C def

43
Q

What are complications of vitamin C deficiency (scurvy)?

A

Hemorrhagic Diathesis
Impaired synthesis of collagen

44
Q

What vitamin def causes may lead to Rickets, a condition that softens the bones from extreme Ca loss?

A

Vitamin D def

45
Q

What vitamin protects cell membranes & tissue damange by oxidation?

A

Vit E

46
Q

What mineral is esential for hydroxylation of Proline?

A

Iron

47
Q

What mineral is essential for normal cross-linking of collagen?

A

Copper

48
Q

What are the diff causes of impaired healing?

A

Malnutrition
acute infection
Hemodynamics
Ulcers in diabetic px
Drugs
Smoking
Radiation

49
Q

What are the 2 types of ischemia caused by diabetic px in wound healing?

A

Regional ischemia - large vessel occlusive dis
Local ischemia - INC blood viscosity secondary to INC red cell rigidity, aggre, & stagnation

50
Q

What condition occurs in diabetic px during wound healing where there is an INC affinity of HbA1c for oxygen?

A

Soft tissue hypoxia

51
Q

What are the diff drugs that can impair wound healing?

A

Steroids
CHemotherapeutic agents
Lathyrogens
Clochicine

52
Q

If a px is undergoing radiation, when can u expect wound healing to occur?

A

36 hrs after wound has formed

53
Q

When should a px stop smoking before and after surgery?

A

2-3 wks BEFORE surgery
1-2 wks AFTER surgery

54
Q

What are the methods of promoting wound healing?

A

Growth factors
Hyperabric O2 therapy
Methods for immunosuppressed px

55
Q

What are the 2 main abnormal response to injury (wound)?

A

Inadquare scar formation
Excessive scar formation

56
Q

How do you tx inadequate scar formation? Give an exmaple

A

Treat underlying defect in scar formation

Ex: Pressure sores - wound should be debrided and cleaned before patching up

57
Q

What are the 2 types of scars that form due to excessive epithelization?

A

Hypertrophic scarring
Keloids

58
Q

WHat type of excessive scar is produced due to dysunctional contractions and does not go beyond the borders of the original wound?

A

Hypertrophic scarring

59
Q

What is the main tx for excessive scar formation?

A

Steroids

60
Q

What type of excessive scar is formed from overgrowth of dense fibous tissue that grows beyond the boders of the orignial wound?

A

Keloids

61
Q

What is the recommended tx for Pre-hypertrophic & keloid scar formation?

A

Silicone (1st line prophylaxis)

62
Q

What is the tx for immature hypertrophic scarring?

A

If erythema persists >1 month, tx w/ Silicone

63
Q

WHat type of tx is given to linear HTS?

A

Silicone

64
Q

What type of tx are given to widespread burn HTS & Minor keloids?

A

Widespread burn HTS: Silicone + Pressure garments
Minor keloids: Silicone + Intralesional corticosteroid

65
Q

In pressure therapy, what is the amt of pressure needed for prolonged periods of time?

A

> 22mmHg

Compression socks

66
Q

What type of steroid is injected to reduce local collagenase inhibitors?

A

Triamcinolone

67
Q

What is the maximal dose of Triamcinolone? Dosage for children to adults?

A

Max dose: every month

1-5 y/o: 40mg
6-10y/o: 80mg
adults: 120mg

68
Q

During surgery, when doing elliptical lincision, ellipse should be how long than the diameter?

A

3-4x longer

Eg. Ellipse of 5mm mole/scar = 15-20mm

69
Q

What are the diff types of excision?

A

Z-plasty
Dermabrasion & Dermaplaning
Skin grafts & flaps
VY-plasty
W-plasty
Elliptical excision & closure

70
Q

What is a characteristic puckering of the skin that can occur after surgical wound closure?

A

Dog ears

71
Q

What type of excision is used to transpose random skin flaps both to break up a linear scar & release a scar contracture through lengthening?

A

Z-plasty

72
Q

What type of excision is used to resurface ur skin & remove fine wrinkles & minimize scars on the skin?

A

Dermabrasion & Dermaplaning

73
Q

What type of excision is done where use of skin above clavicle or behind the ear for grafts to the face & neck?

A

Skin grafts & flaps

74
Q

What are the diff types of skin closure?

A

Simple interrupted
Vertical mattress
Horizontal mattress
Subcuticular continuous
Half-buried horizontal mattress
Continous over-and-over
Staples
Skin tapes

75
Q

What type of sutures provide strength so external sutures can be removed early but do not prevent scar from spreading through time?

A

Buried dermal sutures

76
Q

What are the fundamentals of wound care?

A
  1. Age & Wound healing
    - DEC growth factors
  2. Hypoxia & wound healing
    - hypothermia
  3. Bacteria & wound healing
    - INC production of toxins & proteases
77
Q

What are the adjuncts to wound tx?

A

Debridement
Negative-pressure wound therapy
Dressings
Growth Factors
Enzymes

78
Q

What adjunct to wound tx is given to prepare the wound for healing by reducing bioburden?

A

Debridement

79
Q

What are the 2 types of material used for Dressings? What are their purpose?

A
  1. Polyurethan/Polyethylene
    = permeable to H2O vapor, O2, & other gasses but not to H2O & bacteria
  2. Hydrocolloid sheets
    = impermeable to O2 —> encourages angiogenesis
80
Q

What PDGF derivative is used for txing diabetic foot ulcers & irradiated wounds?

A

Becaplermin (Regranex)

81
Q

what are the 2 types of skin graft?

A
  1. Split thickness: Epidermis + Some dermis
  2. Full-thickness: Epidermis + dermis + some fat
82
Q

What are the 2 phases of skin graft?

A

Serum inhibition: 24-28hrs
Inosculation: 2-5 days
Graft revascularization: >1wk

83
Q

what areas of the body is the common donor site for skin graft?

A

Butt and thigh

84
Q

what is the main donor area of the face when using full-thickness skin graft?

A

back of the ear
above the clavicle

85
Q

which one of split-thickness & full-thickness skin graft has higher chance of survival, resistance, better cosmetic appearance?

A

STSG: High chance of graft survival & Less resistance

FTSG: better quality cosmetic apperance

86
Q

what are the steps in the reconstruction ladder?

A
  1. free tissue transfer
  2. distant tissue transfer
  3. local tissue transfer
  4. tissue expansion
  5. skin grafts
  6. delayed primary intention
  7. primary intention
  8. secondary intention

Surgery (4 decks)

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