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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
What procedure is done visualize all areas of the wound and remove foreign material during wound care?
Physiologic saline irrigation
26
What type of saline is used to clean the wound?
NSS w/o additive 10cc syringe + sterile NSS -> jet stream flushing
27
What is the difference betw Ischemic wounds & well-vascularized wounds?
Ischemic wounds: heals very poorly & becomes infected Well-vascularized: heals very well
28
What are the 3 types of suturing techniques?
Interrupted Continuous Subcuticular
29
What is the most common suturing technique?
Interrupted
30
What are important prerequisites to avoid complicated healing?
Meticulous hemostasis Atraumatic handling of tussues Avoidance of dead space
31
When should sutures be removed in the neck & face + extremities & trunk?
Neck & Face: 3-5 days Extermities & Trunk: 7-10 days
32
What is the % of regained tensile strength in skin, tendon, and fascia after suture?
~70-80%
33
What can happen in re-sutured wounds where non-debridement of wounds edges will accelerate wound healing due to already active fibroblat?
Secondary wound phenomenon
34
What can happen to re-sutured wound that has too much pressure applied on the knot & late removal of skin suture?
Railrod track scar configuration
35
Can epithlization’s process be enhanced in moist environment? How so?
Yes. Saline or emollient dressing can enhance the process
36
What vitamin is given to reverse the inhibitory effect of steroids on epithelization?
Topical vitamin A
37
What process occurs when open wounds shrink due to myofibroblasts contraction?
Wound contraction
38
What region of the body hsa the gastes wound contraction rate?
Face
39
What is the most important aspect in sound healing?
Nutrition
40
When protein is depleted, what can happen to wound healing?
Fibroplasia & Collagen synthesis can be inhiibited
41
What vitamin deficiency causes pellagra (scaly sores, mucosal changes, a& mental symptoms)?
Vitamin B def (Niacin/vit B3)
42
WHat vit deficiency modifies inflam rxn by leading the defect in wound healing like collagen synthesis?
Vitamin C def
43
What are complications of vitamin C deficiency (scurvy)?
Hemorrhagic Diathesis Impaired synthesis of collagen
44
What vitamin def causes may lead to Rickets, a condition that softens the bones from extreme Ca loss?
Vitamin D def
45
What vitamin protects cell membranes & tissue damange by oxidation?
Vit E
46
What mineral is esential for hydroxylation of Proline?
Iron
47
What mineral is essential for normal cross-linking of collagen?
Copper
48
What are the diff causes of impaired healing?
Malnutrition acute infection Hemodynamics Ulcers in diabetic px Drugs Smoking Radiation
49
What are the 2 types of ischemia caused by diabetic px in wound healing?
Regional ischemia - large vessel occlusive dis Local ischemia - INC blood viscosity secondary to INC red cell rigidity, aggre, & stagnation
50
What condition occurs in diabetic px during wound healing where there is an INC affinity of HbA1c for oxygen?
Soft tissue hypoxia
51
What are the diff drugs that can impair wound healing?
Steroids CHemotherapeutic agents Lathyrogens Clochicine
52
If a px is undergoing radiation, when can u expect wound healing to occur?
36 hrs after wound has formed
53
When should a px stop smoking before and after surgery?
2-3 wks BEFORE surgery 1-2 wks AFTER surgery
54
What are the methods of promoting wound healing?
Growth factors Hyperabric O2 therapy Methods for immunosuppressed px
55
What are the 2 main abnormal response to injury (wound)?
Inadquare scar formation Excessive scar formation
56
How do you tx inadequate scar formation? Give an exmaple
Treat underlying defect in scar formation Ex: Pressure sores - wound should be debrided and cleaned before patching up
57
What are the 2 types of scars that form due to excessive epithelization?
Hypertrophic scarring Keloids
58
WHat type of excessive scar is produced due to dysunctional contractions and does not go beyond the borders of the original wound?
Hypertrophic scarring
59
What is the main tx for excessive scar formation?
Steroids
60
What type of excessive scar is formed from overgrowth of dense fibous tissue that grows beyond the boders of the orignial wound?
Keloids
61
What is the recommended tx for Pre-hypertrophic & keloid scar formation?
Silicone (1st line prophylaxis)
62
What is the tx for immature hypertrophic scarring?
If erythema persists >1 month, tx w/ Silicone
63
WHat type of tx is given to linear HTS?
Silicone
64
What type of tx are given to widespread burn HTS & Minor keloids?
Widespread burn HTS: Silicone + Pressure garments Minor keloids: Silicone + Intralesional corticosteroid
65
In pressure therapy, what is the amt of pressure needed for prolonged periods of time?
>22mmHg Compression socks
66
What type of steroid is injected to reduce local collagenase inhibitors?
Triamcinolone
67
What is the maximal dose of Triamcinolone? Dosage for children to adults?
Max dose: every month 1-5 y/o: 40mg 6-10y/o: 80mg adults: 120mg
68
During surgery, when doing elliptical lincision, ellipse should be how long than the diameter?
3-4x longer Eg. Ellipse of 5mm mole/scar = 15-20mm
69
What are the diff types of excision?
Z-plasty Dermabrasion & Dermaplaning Skin grafts & flaps VY-plasty W-plasty Elliptical excision & closure
70
What is a characteristic puckering of the skin that can occur after surgical wound closure?
Dog ears
71
What type of excision is used to transpose random skin flaps both to break up a linear scar & release a scar contracture through lengthening?
Z-plasty
72
What type of excision is used to resurface ur skin & remove fine wrinkles & minimize scars on the skin?
Dermabrasion & Dermaplaning
73
What type of excision is done where use of skin above clavicle or behind the ear for grafts to the face & neck?
Skin grafts & flaps
74
What are the diff types of skin closure?
Simple interrupted Vertical mattress Horizontal mattress Subcuticular continuous Half-buried horizontal mattress Continous over-and-over Staples Skin tapes
75
What type of sutures provide strength so external sutures can be removed early but do not prevent scar from spreading through time?
Buried dermal sutures
76
What are the fundamentals of wound care?
1. Age & Wound healing - DEC growth factors 2. Hypoxia & wound healing - hypothermia 3. Bacteria & wound healing - INC production of toxins & proteases
77
What are the adjuncts to wound tx?
Debridement Negative-pressure wound therapy Dressings Growth Factors Enzymes
78
What adjunct to wound tx is given to prepare the wound for healing by reducing bioburden?
Debridement
79
What are the 2 types of material used for Dressings? What are their purpose?
1. Polyurethan/Polyethylene = permeable to H2O vapor, O2, & other gasses but not to H2O & bacteria 2. Hydrocolloid sheets = impermeable to O2 —> encourages angiogenesis
80
What PDGF derivative is used for txing diabetic foot ulcers & irradiated wounds?
Becaplermin (Regranex)
81
what are the 2 types of skin graft?
1. Split thickness: Epidermis + Some dermis 2. Full-thickness: Epidermis + dermis + some fat
82
What are the 2 phases of skin graft?
Serum inhibition: 24-28hrs Inosculation: 2-5 days Graft revascularization: >1wk
83
what areas of the body is the common donor site for skin graft?
Butt and thigh
84
what is the main donor area of the face when using full-thickness skin graft?
back of the ear above the clavicle
85
which one of split-thickness & full-thickness skin graft has higher chance of survival, resistance, better cosmetic appearance?
STSG: High chance of graft survival & Less resistance FTSG: better quality cosmetic apperance
86
what are the steps in the reconstruction ladder?
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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