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Surgical Procedures 2 > Chapter 11: Wound Healing > Flashcards

Chapter 11: Wound Healing Flashcards

1
Q

Hemostasis

A

To stop bleeding (hemorrhaging)

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2
Q

Ways to stop bleeding

A

Clot formation

Surgical pressure

Ligation

Hemostatic agents

Electrocautery (thermal)

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3
Q

Blood loss is

A

Injury to vessel

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4
Q

Blood loss

Body reacts to

A

Stop hemorrhage

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5
Q

Blood loss

coagulation

A 
Blood clot (thrombus)
Platelets and clotting factors

Vasoconstriction
Slows the flow by narrowing the walls

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6
Q

Blood loss

After vasoconstriction

A

Platelets clump together forming a plug

Release chemicals
Epinephrine
Serotonin
Adenosine diphosphate(ADP)

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7
Q

Blood loss

After vasoconstriction

A

Platelets clump together forming a plug ‘

Release chemicals
Epinephrine
Serotonin
Adenosine diphosphate(ADP)

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8
Q

Phases of the clotting process are as follows

A
  1. Platelets adhere to subendothelium of vessel walls
  2. Platelets release ADP
  3. Release of ADP causes further layers of platelets to adhere
  4. Platelets aggregate forms a thrombus
  5. Permanent thrombus forms after clotting factor reaction
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9
Q

Mechanical hemostasis

Instruments

A

Clamps are used to compress the walls of vessels and to grasp tissue

Most commonly used is the hemostat

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10
Q

Mechanical hemostasis

Ligatures

A

Ties, also called stick ties when a needle is attached

Strands of suture material used to tie off blood vessels

Vessels use smallest possible diameter

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11
Q

Mechanical hemostasis

Clips

A

Used in place of suture ligatures when many small vessels need to be ligated in a short period of time

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12
Q

Mechanical hemostasis

Sponges

A

Used to apply pressure on bleeding areas or vessels

Used to absorb excess blood or body fluid

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13
Q

Sponge types

A

Raytec, also called 4 by 4

Laparotomy sponges, also referred to as lap sponges or tap sponges

Tonsil sponges (round sponges)

Patties (cottonoids)

Kithers and peanuts, also referred to as dissecting sponges

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14
Q

Pledgets

A

For bleeding through needle holes in vessel anastomosis

Small squares of teflon

Sewn over the hole

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15
Q

Suction

A

Used to aspirate

Clear the surgical site

Connected to disposable tubing

Must always be available

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16
Q

Thermal

Electrocautery

A

Most common

Uses heat to coagulate

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17
Q

Thermal

Laser

A

Intense, concentrated beam of light

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18
Q

Bovie button color meaning

A

Blue-coagulate

Yellow-cut

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19
Q

Thermal

Harmonic scalpel

A

Ultrasonic scalpel

Single-use titanium blade

Electrical energy

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20
Q

Pharmacological agents that help in hemostasis

A

Absorbable gelatin (Gelfoam)

Absorbable collagen (Avitene)

Oxidized cellulose (Nu-Knit, Surgi-Cel)

Silver nitrate

Epinephrine

Thrombin

Bone wax

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21
Q

Blood type A

A

Naturally produce anti-b agglutinins

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22
Q

Blood type B

A

Naturally produce anti-a agglutinins

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23
Q

Blood type O

A

Naturally produce both A and B agglutinins

Universal donor

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24
Q

Blood type ab

A

Produce neither antibody

Universal recipients

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25
Rh factor
Used for blood matching Antigenic substance Individuals with the factor are Rh positive Individuals without are Rh negative
26
If Rh positive blood is given to an Rh negative person
Hemolysis will occur Same as mixing incompatible abo blood types
27
Hemolytic transfusion reactions
If blood is not properly matched hemolytic anemia may develop Rh incompatibility Mismatched Can be fetal Agglutination
28
Intention wounds
Chemical Occlusion banding Surgical site infection Incision Excision
29
Traumatic wounds Closed wounds
Skin remains intact, but there's underlying tissue damage
30
Traumatic wounds Open wounds
Skin integrity has been compromised
31
Open wounds Simple
No loss or destruction of tissue
32
Open wound Complicated
Tissue is destroyed, or a foreign body is present
33
Open wounds Clean
Wound edges can be safely be approximated
34
Open wounds Contaminated
May be infected, and be left open and packed May need a debridement
35
Wound classification Chronic wounds
Persist for an extended period of time Bed sores Pressure sores Non healing wounds
36
Inflammatory process
Pain Heat Redness Swelling Loss of function
37
Types of wound healing First intention (primary closure)
Under ideal circumstances Wound heals side to side No separation Minimal scarring
38
Types of wound healing First intention (primary closure) examples
Cicatrix - scar formation Keloid - thickened scar Tensile strength - ability to resist tearing or rupture
39
Types of wound healing Stage 1
Lag phase From injury to 3-5 days Defined by the physiological changes associated with inflammation manifested as heat, redness, swelling, pain, and loss of function
40
Types of wound healing Stage 2
Proliferation phase 3 days to 20 days Fibroblasts multiply and bridge the wound edges
41
Types of wound healing Stage 3
Differentiation phase Day 14 until completely healed Wound undergoes a slow, sustained increase in tissue tensile strength with an interweaving of the collagen fibers
42
Types of wound healing Second intention (granulation)
Wound fails to heal by primary closure Some Sort of breakdown or infection caused breakdown of suture and wound Left open and heals from inside out forming granulation tissue Results in weak and wider scar
43
Types of wound healing Second intention features
Greater tissue loss More inflammatory tissue to remove More granulation tissue (larger scar) Delayed wound contraction Slower process
44
Types of wound healing Third intention (delayed primary closure)
Usually a traumatic wound that needs to be debrided and left open to heal by second intention for 4-6 days Treated with antibiotics and closed to heal by first intention Used for contaminated or dirty wounds
45
Factors influencing wound healing
Age Nutrition Disease Smoking Radiation Immune deficiency
46
Dehiscence
Tissue separation
47
Hematoma
Localized swelling filled with blood resulting from a break in a blood vessel
48
Friable
Easily torn
49
Edema
Condition of abnormally large fluid volume in tissues between the body's cells
50
Evisceration
Exposure of viscera (organs)
51
Exudate
Fluid with a high content of protein and cellular debris that has escaped from blood vessels and has been deposited in tissues or on tissue surfaces, usually as a result of inflammation
52
Gangrene
Decay or death of an organ or tissue caused by a lack of blood supply
53
Granuloma
Mass of inflamed granulation tissue, usually associated with ulcerated infections
54
Hemorrhage
Bleeding
55
Adhesion
Abnormal attachment of scar tissue
56
Herniation
Result of wound dehiscence Weakened tissue
57
Fistula
Tract between 2 surfaces that is open at both ends
58
Sinus tract
A narrow, elongated channel in the body that allows the escape of fluid and open at one end only
59
Ischemia
Decreased supply of oxygenated blood to a body part
60
Keloid scar
Hypertrophic scar formation and occurs most frequently in dark-skinned individuals
61
Seroma
Mass or swelling caused by the localized accumulation of serum with a tissue or organ that can sometimes develop after surgery
62
Wound tension
Excessive tension on the wound edges caused by heavy lifting or straining, or the wound being located on a highly mobile or high tension area
63
Dead space
Separation of wound layers that have not been closely approximated or air that has become trapped between tissue layers
64
Wound classification Class 1 (clean)
Incision made under ideal conditions No break in technique Closed primarily No drain needed No entry into the GI tract or GU tract
65
Wound classification Class 2 (clean contaminated)
Primary closure Wound may be drained Minor break in technique occurred Controlled entry into the GI or GU tract
66
Wound classification Class 3 (contaminated)
Open traumatic wound less than 4 hours old Minor break in technique Acute inflammation present Entry into the GI or GU tract with spillage
67
Wound classification Class 4 (dirty/infected)
Infection rate is 27% to 40% Open traumatic wound (more than 4 hours old) Microbial contamination occurred before the procedure Perforated Viscus
68
Postoperative wound care goal
Prevent infection
69
Postoperative wound care Drains
Remove fluid
70
Postoperative wound care Dressings
Create barrier Sterile technique should be used Promotes wound healing
71
Intraoperative wound care
Involves local and systemic care Sterile technique Tissue perfusion Antibiotics Care should be taken to prevent "dead space"
72
Layer closure for abdominal wound
1. Peritoneum 2. Fascia 3. muscle 4. subcutaneous 5. subcuticular 6. Skin
73
Skin stapler
Used to approximate skin edges during skin closure Disposable device Dispense a single staple with each activation Supplied in a variety of staple quantity and width
74
Linear stapler
Used to insert two straight, staggered, evenly spaced, parallel rows of Staples into tissue
75
Linear cutter
Used to staple and transect the tissue
76
Intraluminal stapler
Used to anastomose tubular structures within the gastrointestinal tract

Surgical Procedures 2 (2 decks)

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