General Surgery

Question 1

Types of wounds

Answer 1

1. Rank and Wakefield 
•Tidy
•Untidy
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2.Based on wound type
Clean incised

Lacerated
Bruise or contusion
Haematoma
Abrasion

Puncture wounds, penetrating wounds
Crush injury
Gun shot injury

Closed Blunt Injury

Injury to bones and joints; nerves, arteries and veins, deeper organs
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3. Based on thickness of the wound
Superficial, Partial, Full thickness
Deep, complicated, penetrating wounds
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4.Based on involvement of structures
•Simple
•Combined
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5. Based on time elapsed
•Acute (show signs of healing in <4weeks)
•Chronic
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6. Surgical wounds
•Clean <2%
(Excision, Sx of Brain joints heart, transplant)

•Clean Contaminated 10%
(Appendicectomy, Bowel Sx,
Gall bladder Biliary Pancreatic Sx)

•Contaminated 15-30%
(Acute Abdominal conditions,
Open Fresh Accidental wounds)

•Dirty infected 40-70%*****
(Abscess drainage, Pyocele,
Empyema Gall Bladder, faecal peritonitis)

Question 2

Phases of wound healing

Answer 2

1. Inflammatory phase
   (lag or substrate or educative)
2. Proliferative Phase
   (Collagen/Fibroblastic)
3. Remodelling Phase
   (Maturation)

STAGES OF WOUND HEALING
•Stage of inflammation
•Stage of granulation tissue formation and organisation

• Stage of epithelialisation
• Stage of scar formation and resorption
• Stage of maturation

Question 3

Factors affecting wound healing

Answer 3

♦️LOCAL FACTORS
🔹Infection
🔹Presence of necrotic tissue and foreign body
🔹Poor blood supply
🔹Venous ot lymph stasis
🔹Tissue tension
🔹Tissue Hypoxia
🔹Haematoma
🔹large defect or Poor apposition 
🔹Recurrent trauma
🔹X-ray irradiated area
🔹Site of wound - wound over joints and Back (Poor healing)
🔹Underlying diseases like osteomyelitis and malignancy
🔹Mech. and type of wound 

♦️GENERAL FACTORS
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(Incised, lacerated, crush, Avulsion)