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Principles of Science > Complications in Wound Healing > Flashcards

Complications in Wound Healing Flashcards

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1
Q

What are Halsted’s principles of surgery?

A 
H - haemosasis
A - aseptic technique
L - light touch (atraumatic)
S - supply of blood preserved
T - tension free closure
E - even tissue apposition 
D - dead space obliterated
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2
Q

What were Esmarchs principles of wound management

A
  • no introduction of anything harmful
  • tissue rest
  • wound drainage
  • avoidance of venous stasis
  • cleanliness
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3
Q

What is post-op haemorrhage usually due to? What else may cause it?

A

> usually due to inadequate haemostasis at Sx
- 1: slipped ligature
- delayed 1: breakdown of ligature
- 2* < LOOK THESE UP
may be due to coagulopathy
- pre-existing eg. vWF
- 2* due to consumption of clotting factors and platelets in massive bleeds

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4
Q

What effect may a haematoma have on wound healing?

A
  • separates wound edges
  • pressure on wound edges -> necrosis and dehiscence
  • prevention of adherence of grafts and flaps
  • physical barrier to leucocyte migration
  • growth medium for bacteria
  • pain
  • organisation of haematoma may cause deformity (usually more cosmetic problem)
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5
Q

How may haemorrhage be managed?

A
  • light pressure bandage 12hrs
  • restrict movement (affected part or hole body - crate)
  • investigate coagulopathy if suspicious
  • supportive care (fluids +- blood prouducts)
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6
Q

How may haematoma be managed?

A
  • none (may spontaneously resolve)
  • aspirate + pressure
  • warm compress tid 7d
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7
Q

Is swelling and oedema normal? What effects may this have on wound healing? DDX?

A
  • normal accumulation of fluid in interstitial space but some wounds more prone to swelling than others
  • may potentiate dehiscence (^ hydrostatic pressure in intersitium reduces vascularity and delays healing)
  • DDx infection and cellulitits - local/regional/diffuse/dependant
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8
Q

What Tx may be used for swelling and oedema?

A
  • Massage
  • Support dressing
  • Removal of constricting sutures
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9
Q

What is seroma and when may it occour?

A
  • collection of serum and tissue fluid in dead space

- one step after oedema

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10
Q

How may seroma affect wound healing?

A
  • tissue separation
  • skin flaps and grafts
  • tension on incision lines
  • interference with blood supply
  • WBC migration impaired`
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11
Q

DDx for seroma?

A
  • haematoma
  • oedema
  • abscess
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12
Q

Tx of seroma?

A

> Usually resolve spontaneously
- try to avoid causing this in the first place!
conservative Tx includes
- aspiration (though may introduce infection)
- control of dead space with bandaging
- control movement
- drainage (active/passive)
- removal of sutures allowing second intention healing
surgical intervention possible but could end up with dehiscence and 2* infection

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13
Q

Causes of seroma

A
  • inflame
  • lymphatic injury
  • poor haemostasis
  • traumatic Sx eg. dissection
  • implants - sutures and drains
  • movement
  • dead space
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14
Q

Give reasons for wound dehiscence

A
  • 1* healing defect

- 2* to surgical technique, judgement, wound bed or trauma

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15
Q

When is dehiscence usually seen?

A

3-5d post surgery (unless self trauma)

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16
Q

Clinical signs of wound dehiscence

A
  • serosanginous discharge
  • swelling
  • necrosis, bruising, discharge
17
Q

Tx of wound dehiscence

A
  • 2* intention healing

- surgical repair (though may end up in same position, find reason for initial dehiscence)

18
Q

Why does wound dehiscence commonly occour following total ear canal ablation?

A
  • sides of the wound uneven

- often infected

19
Q

Which 3 factors influence wound infection?

A
  • bacteria - presence and type [contamination does NOT always = infection]
  • local wound environment
  • local and systemic defence
20
Q

Why may tissue necrosis occour?

A
  • ischaemia (trauma, sx and postop, debridement)

- inadequate debridement -> inflammation, delayed wound healing and ^ risk of infection

21
Q

What may excessive scarrign lead to?

A
  • stenosis eg. anus
  • functional incompetence
  • restriction of movement eg. joints
  • contracture -> loss of function
22
Q

define sinus

A

blind ending tract extending from one epithelial surface (epidermal or mucosal)
deep site of infection, FB or sequestrum

23
Q

define fistula

A

communicating tract extending from one epithelial surface to another eg. oronasal, rectovaginal, brochooesophageal

24
Q

what may commonly cause draining sinus tracts in abdo wounds?

A

grass seed wedged in muscle laye r

25
Q

how may exposed tendon or bone be encrouage to granulate?

A
  • drill holes in bone to expose marrow and cause bleeding [forage holes]
  • skin flap bringing additional blood supply eg. axial pattern flap, microvascular tissue transfer
26
Q

Which stages of healing may be delayed in non-healing wounds?

A
  • Inflammatory
  • Proliferative (granulation formation, epithelisation, contraction)
  • Maturation
27
Q

Why may impairment of the inflammatory phase occour?

A
  • necrotic/devitalised tissue
  • excessive exudate
  • poor blood supply
  • absence of granulation tissue
  • failure of epithelisation
  • chronically painful wound
  • recurrent breakdown
  • infection
28
Q

Why may impairment of the granulation phase occour?

A
  • necrotic or devitalised tissue in wound
  • infection
  • movement
  • poor blood supply
  • mechanical abrasion
29
Q

Tx of impaired granulation tissue formation

A
  • further debridement
  • excision of old granulation tissue
  • enhance blood supply
  • reconstruct using tissue with good blood supply
  • support/mobilisation
30
Q

Why may impairment of epithelialisation occour?

A
  • necrotic tissue in wound
  • infection
  • eschar
  • movement
  • poor blood supply
  • mechanical abrasion surface trauma
31
Q

Tx of impaired epithelialisation

A
  • further debridement
  • Tx infection
  • enhance blood supply (muscle, omentum vascular skin)
  • protection
32
Q

Why may impairment of contraction occour?

A
  • tension in local skin
  • lack of local skin
  • restrictive fibrosis
  • tight bandages
33
Q

Tx of impaired contraction

A
  • excision of restrictive scar

- wound reconstruction using skin flap or graft

34
Q

What is an indolent/pocket wound?

A

Epithelium grows under wound edges -> dead space

35
Q

how should indolent pocket wounds be dealt with?

A
  • identify cause
  • control infection
  • excise wound
  • tension free closure on reconstruction
  • mamagement of dead space
  • enhance local vascular supply (omentalisation)

Principles of Science (27 decks)

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