Exam 3 Wound Closure

Question 1

Wounds closure general rules? (5)

Answer 1

Close anatomical layers
Approximate, don't strangulate
Use anatomical landmarks as guidelines
Eliminate dead space
Avoid tension across edges

Question 2

Primary Wound Closure/Healing by 1st Intention done when?

How?

Best for?

Answer 2

Closed w/i 24 hrs of injury, before development of granulation tissue

Edges are directly approximated

Best for clean, fresh, well-vascularized wounds

Question 3

Secondary Wound Closure/Healing by 2nd Intention is?

Best for?

Answer 3

Wound left open/allowed to close by epithelialization and contraction

Infected/contaminated wounds

Question 4

Tertiary Wound Closure/Healing by 3rd Intention is?

Best for?

Answer 4

Delayed primary closure
U several days post injury

Previously contaminated wounds

Question 5

Traumatic Wound management?

Answer 5

Cleanse surrounding skin
Remove hair
Epi for anesth/bleed control
Irrigation
Debridement

Question 6

Use of betadine/ABX soap in wound care?

Answer 6

Keep away from exposed tissue/out of the wound

Question 7

Do not use epi where?

Answer 7

Areas of P distal ischemia:

ears, digits, nose, penis

Question 8

Leave wounds open when? (5)

Answer 8

Human bites
> 8 hrs post (except for face)
Inflammed/infected
Crushed or ischemic tissue
High, sustained steroid use

Question 9

Scalp wound suture selection?

Answer 9

Skin = 4-0/5-0 microfil or staples
Deep = 4-0 absorb

Question 10

Face wound suture selection?

Answer 10

Skin = 5-0 to 7-0 monofil
Deep = 5-0 absorb

Question 11

Trunk/Extremity suture selection?

Answer 11

Skin = 4-0/5-0 monofil
Deep = 3-0/4-0 absorb

Question 12

Hand suture selection?

Answer 12

Skin = 5-0 monofil
Deep = 5-0 absorb

Question 13

Foot suture selection?

Answer 13

Skin = 3-0/4-0 monofil
Deep = 4-0 absorb

Question 14

Benefits of interrupted sutures?

Drawbacks?

Answer 14

Good for all wound types
Partial removal possible if infection

Slow to place

Question 15

Benefits of continuous sutures?

Drawbacks?

Answer 15

Good for clean wounds
Fast placement/removal

Infection compromises wound

Question 16

Wound dressing for clean wounds stay in place how long?

Answer 16

48 hrs to allow epithelialization

Question 17

Contaminated wounds dressed how?

Answer 17

Packed open

∆d Q 8-12 hrs

Question 18

Wound healing: Early phase includes? (2)

Answer 18

Days 0-4

1) Hemostasis:
Vasoconst/clotting
Cell recrutiment

2) Inflammation:
Vasodilation
WBC/PMN migration to cleanse
Macrophages @ day 3 stim fibroblasts/collagen

Question 19

Wound healing: Intermediate phase includes? (3)

Answer 19

Days 4-30

1) Epithelialization:
Reestablish barrier

2) Angiogenesis:
New capillaries

3) Fibroblasts:
Migrate/proliferate
Build matrix

Question 20

Wound healing: Late phase includes? (3)

Answer 20

1) Matrix deposition:
Glycans/Hyaluronic acid framework for collagen

2) Collagen synth:
Builds CT along stress lines of scar

3) Wound contraction:
Closes edges during collagen synth
Lasts ~15 days

Question 21

Wound healing: Final phase includes? (2)

Answer 21

Days 30 - 2 yrs

1) Scar remodeling/maturation:
Collagen continues to organize and becomes dense
Scar becomes avascular/acellular

2) Wound strength:
85% of strength @ 6 wks
90% @ 6 mo
Never reaches 100%