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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
Q

Rh factor

A

Used for blood matching

Antigenic substance

Individuals with the factor are Rh positive

Individuals without are Rh negative

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26
Q

If Rh positive blood is given to an Rh negative person

A

Hemolysis will occur

Same as mixing incompatible abo blood types

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27
Q

Hemolytic transfusion reactions

A

If blood is not properly matched hemolytic anemia may develop

Rh incompatibility

Mismatched

Can be fetal
Agglutination

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28
Q

Intention wounds

A

Chemical

Occlusion banding

Surgical site infection
Incision
Excision

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29
Q

Traumatic wounds

Closed wounds

A

Skin remains intact, but there’s underlying tissue damage

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30
Q

Traumatic wounds

Open wounds

A

Skin integrity has been compromised

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31
Q

Open wounds

Simple

A

No loss or destruction of tissue

32
Q

Open wound

Complicated

A

Tissue is destroyed, or a foreign body is present

33
Q

Open wounds

Clean

A

Wound edges can be safely be approximated

34
Q

Open wounds

Contaminated

A

May be infected, and be left open and packed

May need a debridement

35
Q

Wound classification

Chronic wounds

A

Persist for an extended period of time

Bed sores

Pressure sores

Non healing wounds

36
Q

Inflammatory process

A

Pain

Heat

Redness

Swelling

Loss of function

37
Q

Types of wound healing

First intention (primary closure)

A

Under ideal circumstances

Wound heals side to side

No separation

Minimal scarring

38
Q

Types of wound healing

First intention (primary closure) examples

A

Cicatrix - scar formation

Keloid - thickened scar

Tensile strength - ability to resist tearing or rupture

39
Q

Types of wound healing

Stage 1

A

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
Q

Types of wound healing

Stage 2

A

Proliferation phase

3 days to 20 days

Fibroblasts multiply and bridge the wound edges

41
Q

Types of wound healing

Stage 3

A

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
Q

Types of wound healing

Second intention (granulation)

A

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
Q

Types of wound healing

Second intention features

A

Greater tissue loss

More inflammatory tissue to remove

More granulation tissue (larger scar)

Delayed wound contraction

Slower process

44
Q

Types of wound healing

Third intention (delayed primary closure)

A

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
Q

Factors influencing wound healing

A

Age

Nutrition

Disease

Smoking

Radiation

Immune deficiency

46
Q

Dehiscence

A

Tissue separation

47
Q

Hematoma

A

Localized swelling filled with blood resulting from a break in a blood vessel

48
Q

Friable

A

Easily torn

49
Q

Edema

A

Condition of abnormally large fluid volume in tissues between the body’s cells

50
Q

Evisceration

A

Exposure of viscera (organs)

51
Q

Exudate

A

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
Q

Gangrene

A

Decay or death of an organ or tissue caused by a lack of blood supply

53
Q

Granuloma

A

Mass of inflamed granulation tissue, usually associated with ulcerated infections

54
Q

Hemorrhage

A

Bleeding

55
Q

Adhesion

A

Abnormal attachment of scar tissue

56
Q

Herniation

A

Result of wound dehiscence

Weakened tissue

57
Q

Fistula

A

Tract between 2 surfaces that is open at both ends

58
Q

Sinus tract

A

A narrow, elongated channel in the body that allows the escape of fluid and open at one end only

59
Q

Ischemia

A

Decreased supply of oxygenated blood to a body part

60
Q

Keloid scar

A

Hypertrophic scar formation and occurs most frequently in dark-skinned individuals

61
Q

Seroma

A

Mass or swelling caused by the localized accumulation of serum with a tissue or organ that can sometimes develop after surgery

62
Q

Wound tension

A

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
Q

Dead space

A

Separation of wound layers that have not been closely approximated or air that has become trapped between tissue layers

64
Q

Wound classification

Class 1 (clean)

A

Incision made under ideal conditions

No break in technique

Closed primarily

No drain needed

No entry into the GI tract or GU tract

65
Q

Wound classification

Class 2 (clean contaminated)

A

Primary closure

Wound may be drained

Minor break in technique occurred

Controlled entry into the GI or GU tract

66
Q

Wound classification

Class 3 (contaminated)

A

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
Q

Wound classification

Class 4 (dirty/infected)

A

Infection rate is 27% to 40%

Open traumatic wound (more than 4 hours old)

Microbial contamination occurred before the procedure

Perforated Viscus

68
Q

Postoperative wound care goal

A

Prevent infection

69
Q

Postoperative wound care

Drains

A

Remove fluid

70
Q

Postoperative wound care

Dressings

A

Create barrier

Sterile technique should be used

Promotes wound healing

71
Q

Intraoperative wound care

A

Involves local and systemic care
Sterile technique
Tissue perfusion
Antibiotics

Care should be taken to prevent “dead space”

72
Q

Layer closure for abdominal wound

A
  1. Peritoneum
  2. Fascia
  3. muscle
  4. subcutaneous
  5. subcuticular
  6. Skin
73
Q

Skin stapler

A

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
Q

Linear stapler

A

Used to insert two straight, staggered, evenly spaced, parallel rows of Staples into tissue

75
Q

Linear cutter

A

Used to staple and transect the tissue

76
Q

Intraluminal stapler

A

Used to anastomose tubular structures within the gastrointestinal tract

Surgical Procedures 2 (2 decks)

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