Chapter 6

Question 1

1.Understand the concept of Langer’s Lines. What are “two” advantages of using this knowledge when doing minor surgery?

Answer 1

COrespond to collagen fiber orientation in skin - parallel

• Follow the lines to:
  
  • minimize wound tension
  • Heal faster/less scarring
  • less chance of keyloid

Question 2

2.What are the “problem areas” of the body for increased risk of scarring/keloids?

Answer 2

Upper chest
back
shoulders

Question 3

3.How do Kraissl’s lines compare to Langer’s Lines?

Answer 3

Langer’s lines - dead bodies

Kraissls lines - observed in living people

Question 4

4.When a wound occurs what, essentially, is the body’s only interest?

Answer 4

Survival -

- less concern about beautiy and 100% functionality

Question 5

5.Be able to list and describe (what is occurring in each stage) of the three phases of healing (Slide #11).

Answer 5

Phase one - inflammation , tumor, dolor, calor, rubor couple days, debridement ; leukocytes, macrophages
Phase 2 - 5-3wk: fibroblasts, myofibroblast, wound contraction, granulation
Phase 3: wound contratction, crosslinking, scars

Question 6

6.What is the average tissue strength of a healing wound when the sutures are removed at 10-14 days?

Answer 6

2 weeks ; 5-6%

2 years: maybe 95% of strength, it never goes to 100%

Question 7

7.Understand the difference between clean, clean-contaminated, dirty/contaminated and infected wounds.

Answer 7

Clean: free from organism/surgery, closed by primary closure, done under sterile conditons, not predisposed to infection.
clean contaminated: wound contaminated prior to being seen,

Question 8

8.Is there a “Golden Period” of time for closing lacerations?

Answer 8

Not anymore, it used to be 8 hours or 12-24 on face

Question 9

9.What are the four “Goals of Surgery”?

Answer 9

1. close the wound
2. no infection during healing
3. small scar
4. no loss of function

Question 10

10.What factors involving the patient and surgeon affect wound repair?

Answer 10

patient:
- age, weight, nutrition status, health, etc
doctor
- length/direction no fwound
- remove necrotic tissue
- properly closing
- dead space elimination

Question 11

11.Understand the concept of “Healing by First (Primary) Intention”. What are the goals and outcomes of this method?

Answer 11

Primary: sew it up immediately

- limit infection, scarring,

Question 12

12.What are the two possibilities that lead to a wound “Healing by Secondary Intention”? Can it be a reasonable choice made by the patient or surgeon? What are its advantages and disadvantages?

Answer 12

• WOund fails to heal by primary intention
• purposely left open, paper cut , skinned knee
• larger scars, takes long time,
• its simle, low risk of infection

Question 13

13.Describe the steps in “Delayed Primary Closure (DPC)”. When should it be used? What are its advantages?

Answer 13

• decrease infection rates in contaminated wounds

- extream tissue lost

Question 14

13.Describe the steps in “Delayed Primary Closure (DPC)”. When should it be used? What are its advantages?

Answer 14

1- debride
2- leave open
3. pack with strile dressing
4. cover with support bandage repeat daily
5. granulation - pushes sterile dressing out
6. close when enough healthy tissue develops

Question 15

14.What are the advantages of using a “running” stitch”? Where on the body is this a good stitch to use?

Answer 15

when you need them in fast:
Theres little or no tension
- eyelid, neck, scrotum….loose skin
Don’t use to close dead space