Chapter 7 - Integumentary System

Question 1

Avascular

Answer 1

A lack in blood supply, devitalized, necrotic, and nonviable. Specific types include slough and eschar.

Question 2

Clean Wound

Answer 2

Wound is free of devitalized tissue, purulent drainage, foreign material, or debris.

Question 3

Closed Wound Edges

Answer 3

Edges of top layers of epidermis have rolled down to cover lower edge of epidermis, so epithelial cells cannot migrate from wound edges; also described as epibole. Presents clinically as sealed edge of mature epithelium; may be hard/thickened; may be discolored (for example, yellowish, gray, white).

Question 4

Dehisced/Dehiscence

Answer 4

To split apart or open along natural or sutured lines.

Question 5

Epidermis

Answer 5

Outermost layer of skin

Question 6

Epithelization

Answer 6

Regeneration of epidermis across a wound surface.

Question 7

Eschar

Answer 7

Black or brown necrotic, devitalized tissue; tissue can be loose or firmly adherent, hard, soft, or soggy.

Question 8

Full-thickness

Answer 8

Tissue damage involving total loss of epidermis and dermis and extending into the subcutaneous tissue and possibly into muscle or bone.

Question 9

Granulation Tissue

Answer 9

The pink/red, moist tissue comprised of new blood vessels, connective tissue, fibroblasts, and inflammatory cells, that fills an open wound when it starts to heal; it typically appears deep pink or red with an irregular, berry-like surface.

Question 10

Healing Ridge

Answer 10

Palpatory finding is indicative of new collagen synthesis. Palpation (feeling or touching) reveals induration (hardening) beneath the skin extending to about one centimeter on each side of the wound. Becomes evident between five and nine days after wounding; typically persists until about 15 days after the wound occurs. This is an expected positive sign.

Question 11

Infection

Answer 11

The presence of bacteria or other microorganisms is in sufficient quantity to damage tissue or impair healing. Wounds can be classified as infected when the wound tissue contains 105 or more microorganisms per gram of tissue. Typical signs and symptoms of infection include purulent exudates, odor, erythema, warmth, tenderness, edema, pain, fever, and elevated white cell count; however, clinical signs of infection may not be present, especially in the immuno-compromised patient or the patient with poor perfusion (circulation of blood through the vascular bed of tissue).

Question 12

Nongranulating

Answer 12

Absence of granulation tissue, wound surface appears smooth as opposed to granular. For example, when a wound is clean but nongranulating, this indicates the wound surface appears smooth and red as opposed to berry-like.

Question 13

Partial-thickness

Answer 13

Damage does not penetrate below the dermis and may be limited to the epidermal layers only.

Question 14

Sinus tract

Answer 14

Course of tissue destruction. It occurs in any direction from the surface or edge of the wound; and, it results in dead space with potential for abscess formation. It’s also called tunneling. (It can be distinguished from undermining by the sinus tract involving a small portion of the wound edge; whereas undermining involves a significant portion of wound edge.)

Question 15

Slough

Answer 15

Soft, moist avascular (devitalized) tissue may be white, yellow, tan, or green; may be loose or firmly adherent.

Question 16

Undermining

Answer 16

Area of tissue destruction extends under the intact skin along the periphery of a wound; commonly seen in shear injuries.

Question 17

Electrodesiccation

Answer 17

This process destroys tissue using a small instrument with a cautery needle connected to a monopolar electric source. Electricity is the source of heat as it passes through cautery blade or needle. As the needle touches tissue, the tissue is burned away (destruction).

Question 18

Electrofulguration

Answer 18

this process destroys tissue using high frequency electric current. An insulated electrode with a metal point is held above the surface of the lesion while electrical sparks are generated in sufficient quantity to destroy the tissue. After a layer of cells is destroyed, it is scraped away with a curette (small, sharp, ring-shaped instrument). This process is repeated until the lesion is removed. This method results in a wide border of normal tissue being removed along with the malignant lesion (destruction).

Question 19

Elliptical Excision

Answer 19

The physician usually marks the skin externally before the first incision is made. The length of the ellipse is usually two to three times the required width. The incision is through the dermis with some subcutaneous fatty tissue visible when the tissue is excised.

Question 20

Pilonidal Cyst

Answer 20

a sac under the skin at the base of the spine that can become infected

Question 21

Advancement Flap

Answer 21

Undermining or freeing up tissue (from underlying fibrous attachments) surrounding a defect creates an advancement flap. This tissue is now free to move forward into the defect and be sutured to the other wound edge. This type of tissue transfer does not include any side or rotational movement of the tissues freed for advancement.

Question 22

Allograft

Answer 22

The skin graft is transplanted from one person to another who is not genetically identical; also called an allogenic skin graft.

Question 23

Autograft/Autologous

Answer 23

Skin graft is harvested from another healthy part of the patient’s own body

Question 24

Composite Graft

Answer 24

This term refers to skin grafts including more than one type of tissue. The multiple tissues are aligned and used to plug a defect. This type of graft is usually done for both structural and cosmetic reasons

Question 25

Derma-Fascia-Fat Grafts

Answer 25

This service is performed to smooth out blemishes created secondary to surgically created defects or atrophy.

Question 26

Double Pedicle Flap

Answer 26

An incision is made in the skin along the length of the defect to be closed and the tissue between the incision and the edge of the defect is freed, leaving the ends of the flap attached. The flap is moved into place over the defect and the edges are sutured. The double pedicle flap allows the blood supply to the tissue flap to be maintained from both ends of the flap

Question 27

Free Fascia Graft

Answer 27

This type of graft requires the elevation and transfer of fascia with microvascular anastomosis.

Question 28

Full-thickness Graft

Answer 28

Graft is composed of epidermis and layers of the dermis. The graft is cut with a scalpel, placed over the defect, and sutured into place.

Question 29

Heterograft/Xenograft

Answer 29

a graft material transferred between species (for example, a skin graft section made of pigskin that functions as a biological dressing).

Question 30

Homograft

Answer 30

The graft material originates from two individuals of the same species who are not genetically identical (for example, skin harvested from a cadaver and used as temporary cover). These grafts are commonly used only about 10 days, though they may last four to five weeks. They are usually used to cover large burns and stimulate the growth of new skin beneath them.

Question 31

Rotation Graft

Answer 31

A skin incision is made to create a curvilinear flap contiguous with the defect. When the flap is dissected free, it is pivoted into place over the defect and sutured into place. The defect created in making the flap is sutured or repaired with an additional graft, as necessary.

Question 32

Split-thickness Graft

Answer 32

The graft is composed of epidermis and a small portion of the dermis.

Question 33

Complete Mastectomy

Answer 33

The breast tissue as well as the skin, nipple, and areola are removed.

Question 34

Gynecomastia Mastectomy

Answer 34

The term describes the abnormal enlargement of one breast or both breasts in men. Excess fat and breast tissue are removed from the breast area, generally by dissecting the tissue away from the pectoralis fascia. The skin, nipple, and areola remain intact.

Question 35

Modified Radical Mastectomy

Answer 35

This procedure describes removal of breast tissue and includes skin, nipple, areola, and axillary lymph nodes, with or without the pectoralis minor muscle. The procedure differs from the radical mastectomy because the pectoralis major muscle is not removed.

Question 36

Partial Mastectomy

Answer 36

A portion of the breast tissue, which involves more than removal of a lesion or tumor, is described by this term. Some normal tissue, in addition to the abnormal growth or lesion, may be included. In some cases, as much as a quadrant or segment of breast tissue may be removed.

Question 37

Radical Mastectomy

Answer 37

Breast tissue associated with skin, nipple, areola, axillary lymph nodes, pectoralis major, and minor muscles are removed.

Question 38

Urban Mastectomy

Answer 38

This type is similar to radical mastectomy but includes the internal mammary lymph nodes.

Question 39

Actinic keratosis

Answer 39

A premalignant warty lesion occurring on sun-exposed skin of the face or hands in aged, light-skinned people.

Question 40

Delayed primary closure

Answer 40

A combination of primary and secondary closure. After decontamination and cleansing, the wound is left open to watch for a couple of days. When the wound appears to be on its way to healing, it is closed surgically.

Question 41

dysplastic nevus

Answer 41

Cutaneous pigmented lesions with notched, irregular borders, considered pre-malignant.

Question 42

Impetigo

Answer 42

A contagious superficial pyoderma, caused by Staph or group A Strep.

Question 43

Gynecomastia

Answer 43

Excessive development of the male mammary glands.

Question 44

Primary Closure

Answer 44

Edges of a wound are even and well-approximated. These wounds heal very quickly. A good example of a wound that heals by primary closure is a surgical incision.

Question 45

Secondary Closure

Answer 45

Occurs when the edges of a wound cannot be brought together. The wound gradually fills in and heals on its own. Areas such as the forehead or temple may heal better by secondary intention.