Final Flashcards
What are Langer’s Lines? What are two advantages of using this knowledge when doing minor surgery?
Topological lines that correspond to the natural orientation of collagen fibers and parallel to the orientation of the underlying muscle fibers. Incisions made parallel to these lines minimize wound tension, heal faster, and produce less scarring than those cut across.
What are the “problem areas” of the body for increased risk of scarring/keloids?
Upper chest
Back
Shoulders
How do Kraissl’s lines compare to Langer’s lines?
Kraissl’s lines are based on observations in living people
When a wound occurs what, essentially, is the body’s only interest?
Survival
What are the three phases of healing?
Inflammatory (2-5 days)
Proliferative (5 days to 3 weeks)
Maturation (3 weeks to 2 years)
What is the average tissue strength of a healing wound when the sutures are removed at 10-14 days?
5-6%
Understand the difference between clean, clean-contaminated, dirty/contaminated and infected wounds.
Clean - free from microorganisms
Clean-contaminated - non-significant contamination and less than 6h elapsing until medical care
Contaminated - without local infxn and more than 6h elapsing until medical care
Infected - intense inflammatory reaction and frank infectious process
Is there a “Golden Period” of time for closing lacerations?
Not really
What are the four “Goals of Surgery”?
- Close the wound efficiently
- No infection
- As small a scar as possible
- No loss of function
What factors involving the patient and surgeon affect wound repair?
Surgeon’s responsibility is in the areas of aseptic and quality technique. The patient’s is their overall health status.
Understand the concept of “Healing by First (Primary) Intention”. What are the goals and outcomes of this method?
A clean wound that is closed promptly with no complications during healing leaving a minimal scar.
What are the two possibilities that lead to a wound “Healing by Secondary Intention”? Can it be reasonable choice made by the patient or surgeon?
- Wound fails to heal via primary intention due to excessive tissue trauma/loss or imprecise approximation
- Wound is left open on purpose because it is small or drainage needs to occur
Describe the steps in “Delayed Primary Closure (DPC)”.
- Debride
- Leave open
- Pack with sterile dressing
- Cover with bandage and redress often
- When healthy granulation tissue has developed, suture close
What are the advantages of using a “running” stitch? Where on the body is this a good stitch to use?
Faster to perform.
Valuable on eyelids, neck, and scrotum (places of loose skin)
What are the advantages and disadvantages of letting a wound heal by secondary intention?
Pros: Simplicity and low risk of infection
Cons: Length of time needed to heal and larger scar
When should DPC be used? What are its advantages?
Recommended for heavily contaminated wounds where there is extensive tissue loss and a high risk of infection
Know the various steps to performing an I and D of an abscess (10 steps)
- Anesthetize
- Lyse with #11
- Let contents drain
- Gently express contents
- Break up any pockets
- Pack cavity with iodine gauze
- Dress wound daily
- Return in 3 days to change drain and remove any new pus
- Repack with less
- Repeat daily dressings
What are the possible pitfalls of attempting to drain an abscess before it has formed?
Bleeding without obtaining drainage
Potential of spreading the infection
Why use a cruciate incision?
Helps prevent premature wound closing during drainage/healing
What does it mean to “advance the drain”?
Patient gradually pulls out the drain an inch or so a day, and trimming off the end
What ratio and angles should ellipses be at?
3:1 at a 30 degree angle at the ends
Why is the goal to cut skin edges perpendicular to the surface when doing elliptical excisions?
It allows for better eversion and closure
Know the options for treatment when a wound dehisces.
Let heal by secondary intention for partial
For larger, resuture if no sign of infection and less than 24hrs has passed
What are the two options as methods of anesthesia for removing part/all of a finger/toenail?
Digital block
Block at the proximal end of the proximal carpal between the digits
Name two reasons for/advantages of using a running lock stitch.
If you need a watertight seal
Gathering of loose skin
Name the several different ways to deal with “bleeders” that may appear in a surgical wound or traumatic laceration.
Wait for them to clot Apply pressure Clamp Cauterize Tie-off