Dermatology/ Skin Wounds

Question 1

Prior to skin closure, what preventative measures should you take against tissue infection?

Answer 1

• wound irrigation, foreign body removal, and debridement of necrotic material

Question 2

Are prophylactic antibiotics indicated for a clean, nonbite wound after suturing?(6)

Answer 2

No. Antibiotics are used only if the wound is excessively contaminated, is in the mouth, caused by an animal or human bite, or the patient has vascular insufficiency or immunocompromise.

Question 3

What are the different properties of suture material that you should consider when selecting one for wound closure?(4)

Answer 3

• Monofilamentous (Prolene or Ethilon) or multifilamentous (silk)
• tensile strength (higher number = thinner suture and less strength)
• memory (high memory = stiff, harder to tie, such as prolene)
• absorbable versus nonabsorbable

Question 4

Describe the properties of the most common nonabsorbable sutures.

Nylon (4)

Answer 4

Question 5

Describe the properties of the most common nonabsorbable sutures.

Prolene (4)

Answer 5

Question 6

Describe the properties of the most common nonabsorbable sutures.

Silk (4)

Answer 6

Question 7

What theoretical advantage do monofilament sutures have over multifilament?

Answer 7

Multifilament sutures can facilitate bacteria between strands and increase infection rates.

Question 8

What are examples of absorbable sutures (sutures that lose their tensile strength within 60 days)?

Answer 8

• Vicryl, monocryl, dexon, PDS, maxon

Question 9

What is the most common suturing technique for an uncomplicated wound?

Answer 9

Simple, interrupted sutures with nonabsorbable suture

Question 10

After how many days should you remove sutures in the in the Eyelids/Neck?

Answer 10

3 days

Question 11

After how many days should you remove sutures in the in the Face?

Answer 11

5 days

Question 12

After how many days should you remove sutures in the in the Scalp?

Answer 12

7-10 days

Question 13

After how many days should you remove sutures in the in the Extremities?

Answer 13

7-10 days

Question 14

What are contraindications to the use of tissue adhesive for wound closure?

Answer 14

Complex laceration pattern, dirty wound, wound tension, wound length or depth >10 cm

Question 15

What instructions should you give a patient after using tissue adhesive to close a wound?

Answer 15

• do not use antibiotic ointment over wound (leads to premature breakdown)
• return for wound check in 2 days
• do not pull at adhesive as it starts to wear off

Question 16

What is the wound closure method of choice for superficial skin flaps in the elderly?

Answer 16

Wound tape

Question 17

What wound closure method is suggested for scalp lacerations and lacerations over hair-bearing areas?

Answer 17

Staples