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Fall 2024 > CS2 - Wound Closure > Flashcards

CS2 - Wound Closure Flashcards

1
Q

Wound closure indications?

A

Decrease time of wound healing
Reduce risk of infection
Cosmetic, reduce scar tissue
Repair the loss of structure and/or function of tissue

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2
Q

Wound closure precautions/contraindications

A
  1. Most need closed w/i 8 hours of injury
  2. increased vascularity can be closed w/i 24 hours
  3. Contaminated wounds
  4. Wounds with foreign body
  5. Wounds with extensive involvement of tendons, nerves, or arteries
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3
Q

What are the potential complications of wound closure?

A

Infection
Scarring
Keloid formation
Loss of function/structure
Cosmetic
Wound dehiscence
Tetanus

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4
Q

Describe the epidermis

A

Stratum germinativum - provides cells for new epidermal formation

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5
Q

In what later of the skin are the nerves and blood vessels?

A

subcutaneous fat and fascia

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6
Q

Describe langer lines

A

tension/cleavage lines; orientation of collagen fibers
parallel wounds = approximate better
perpendicular wounds = can lead to gaping wounds

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7
Q

What are the types of wounds?

A

Clean
clean-contaminated
contaminated
infected

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8
Q

Describe a clean wound

A

Aseptic technique is utilized to created wound; excludes GI, respiratory or GU tract

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9
Q

Describe a clean-contaminated wound

A

Aseptic technique utilized but involves the GI, GU or respiratory tract

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10
Q

Describe a contaminated wound

A

Traumatic wounds

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11
Q

Describe an infected wound

A

Infection present prior to incision, i.e. abscess (I&D) and highly contaminated wounds

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12
Q

What is primary intention

A

All layers are closed
Clean or clean-contaminated wounds

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13
Q

What is secondary intention

A

Closure of deep layers, superficial layers left open

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14
Q

When is wound care required for secondary intention

A

irrigation, packing, and/or dressing

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15
Q

When is secondary intention indicated?

A

wounds with infection or tissue loss

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16
Q

What is third intention/delayed primary intention

A

Deep layers closed, superficial layers are left open and reassessed for closure on day 4-5

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17
Q

In the case of third intention, if the wound is reassessed and granulation has begun with no infection, what should be done?

A

irrigate and close

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18
Q

In the case of third intention, if the wound is reassessed and there is an infection, what should be done?

A

Secondary intention

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19
Q

When is third intention/delayed primary intention indicated?

A

Contaminated wounds

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20
Q

What history should be gathered from a patient with a wound

A
  1. injury related questions
  2. PMHx, Social/occupational hx, meds, allergies
  3. Tetanus status***
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21
Q

What should be objectively evaluated when a patient presents with a wound

A
  1. Type of wound and location
  2. Extent of injury
  3. Contamination
  4. Sensory and motor examination***
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22
Q

What size/timeframe makes a wound tetanus-prone?

A

> 6 hours and > 1 cm deep

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23
Q

What shape/tissue type makes a wound tetanus-prone?

A

Stellate or avulsion wound
Devitalized tissue

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24
Q

What types of contamination make a wound tetanus-prone?

A

Soil
Feces
Saliva

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25
Q

What mechanisms of injury make a wound tetanus-prone

A

missile
puncture
crush
burn
frostbite

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26
Q

What should be considered about tetanus update if primary immunizations were completed?

A

Non-tetanus prone - 10 years
Tetanus prone - 5 years
If tetanus and >5 years, give Tdap if less than 65; if >65 case by case decision
If Hx of Tdap, Td recommended

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27
Q

What should be considered about tetanus if immunization status is inadequate or unknown

A

If tetanus prone, give Tdap and TIG at time of injury:
step 1: Tdap
step 2: Td 4-8 weeks
step 3: Td 6-12 weeks after #2

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28
Q

What is the use of local anesthesia?

A

Reversible blockage of sensory nerves responsible for perception of pain, temperature, and pressure

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29
Q

What are the two main categories of local anesthesia

A

Esters and amides

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30
Q

What are the esters

A

Benzocaine and novocaine

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31
Q

What are the amides

A

Lidocaine and carbocaine

32
Q

When is local anesthesia indicated

A

Minor surgical procedures like laceration repair

33
Q

What can be added to anesthetic and why?

A

Epinephrine:
1. decrease blood flow which reduces systemic absorption
2. Shortens the time of onset of anesthetic
3. Lengthens the duration of anesthetic effect

34
Q

When is local anesthesia contraindicated?

A

Allergy to the substance
Unstable BP
Amide - severe liver disease
Ester - severe renal disease

35
Q

When is epi contraindicated?

A
  1. Locations with a single blood supply (fingers/toes, tip of nose, ears, penis)
  2. Untreated hyperthyroidism or pheochromocytoma
  3. Severe HTN or CAD
36
Q

What are the relative contraindications for epi?

A

Pregnancy
Untreated HTN
Concurrent BB
MAOIs
TCAs

37
Q

What are the potential complications of local anesthesia?

A

Vasovagal syncope
Bruising
Infection
Temporary nerve paralysis

38
Q

What are the systemic complications of local anesthesia?

A

Hypotension
Bradycardia
CNS depression

39
Q

What are the complications of using epi with local anesthesia?

A

Cardiac dysrhythmias
Hypertension
Anxiety
Tissue necrosis

40
Q

What are the needle/syringe sizes for local anesthesia?

A

18 gauge needle for drawing up solution
27-30 gauge with 0.5 to 1.5 inch needle for injection
5-10 mL syringe

41
Q

Describe the procedure when directly infiltrating the wound with local anesthesia

A
  1. Start proximally and inject at the area between the dermis and subQ
  2. Prior to injection, aspirate to ensure not in a vessel
  3. Reposition, then repeat until all edges are anesthetized
42
Q

How much anesthesia should be given according to laceration size?

A

A 3-4 cm laceration = 3-5 mL of anesthesia

43
Q

What should be done to the wound before closure?

A

Irrigation
Cleansing
Debridement

44
Q

How should the wound be irrigated?

A

Use 60mL syringe and irrigation needle to adequately irrigate wound with short bursts of NSS; small = 250-500mL, larger = liters

45
Q

How should the wound be cleansed

A

Apply chosen cleansing agent to wound edges and surrounding skin in a circular motion; repeat 3 times

Avoid cleansing within wound

Place sterile fenestrated drape over wound and additional sterile drapes as needed

46
Q

How should the wound be debrided?

A

If needed, scalpel or tissue scissors to remove the dead tissue

47
Q

What are the 2 main types of suture material

A

Absorbable and non-absorbable

48
Q

When is it indicated to use absorbable sutures?

A

mucosal surface
oral cavity
deep closures

49
Q

What are examples of absorbable sutures?

A

plain or chromic gut
Vicryl

50
Q

What are the two types of absorbable sutures?

A

Monofilament: single stranded
Multifilament: braided strands

51
Q

What materials can make up monofilament sutures?

A

Nylon
Polypropylene (Prolene)

52
Q

What is an example of material for multifilament sutures?

A

silk

53
Q

What size monofilament for the scalp?

A

5-0/4-0

54
Q

What size monofilament for the Face?

A

6-0

55
Q

What size monofilament for the trunk/back/extremities

A

5-0/4-0

56
Q

What size monofilament for the foot?

A

4-0/3-0

57
Q

What type of suture needle should be used for skin?

A

Conventional cutting needle

58
Q

What type of suture needle should be used for skin and tougher tissue like ligaments?

A

Reverse cutting needle

59
Q

What type of suture needle should be used for the peritoneum?

A

Taper needle

60
Q

What is the correct grasp of needle rule?

A

2/3: 1/3 ratio

61
Q

What type of stitch should be done for simple laceration repairs?

A

simple interrupted stitch

62
Q

What are some additional stitching techniques?

A

continuous running stitch
running subcuticular stitch
vertical mattress (deep wounds)
horizontal mattress (redistribute tension)
Retention sutures

63
Q

When are skin staples indicated?

A

Linear lesions located at the scalp or the trunk

64
Q

When are skin staples not indicated?

A

Face, hands, joints, and potential for imaging

65
Q

When are skin adhesives indicated?

A

surgical incisions; fast and non-invasive application

66
Q

When are skin adhesives not indicated?

A

Skin creases
hands
infection
mucosal surfaces
areas of dense hair distribution

67
Q

How long does skin adhesive last?

A

5-10 days

68
Q

What are some post-procedure instructions for patients?

A
  1. keep clean and dry, do not soak
  2. provide info on wound checks and dressing changes
  3. review signs/symptoms of infection
  4. consider immobilization
  5. discuss analgesics
  6. educate pt. on healing, scarring, avoid sun, and timing of removal
  7. +/- antibiotics
69
Q

How long should sutures/staples stay in scalp?

A

6-8 days

70
Q

How long should sutures stay in face?

A

4-5 days

71
Q

How long should sutures stay in chest/abdoment?

A

8-10 days

72
Q

How long should sutures stay in back?

A

12-14 days

73
Q

How long should sutures stay in arms/legs?

A

~10 days (add 2-3 if extensor surface)

74
Q

How long should sutures stay in hands/feet?

A

10-14 days (add 2-3 if extensor surface)

75
Q

How should sutures be removed?

A

Avoid pulling exposed material through the wound
Remove all suture material in its entirety

76
Q

How should staples be removed?

A

Align remover in the middle of the staple
Squeeze device on staple, then lift up

77
Q

What should the aftercare include for suture/staple removal?

A

+/- antibacterial ointment
Most do not require additional dressing
Mild redness is normal

Fall 2024 (34 decks)

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