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Technique ST > Hemostasis, Wound Healing & Wound Closure > Flashcards

Hemostasis, Wound Healing & Wound Closure Flashcards

1
Q

Wound Classification for the following Ex. Coronary Artery Bypass Graft, Total Hip, Breast Biopsy & Craniotomy
lap, mastectomy, neck
dissection, thyroid, vascular, hernia & splenectomy

A

Clean (Class 1)
Uninfected, uninflamed operative wound in which the respiratory, alimentary, genital or uninfected urinary tracts are not entered.

. Primary closure
. No inflammation is encountered
. Closed wound drainage device if necessary
. Incision made under ideal surgical conditions
. No break in sterile technique during procedure
. No entry to aerodigestive or genitourinary tract
– Respiratory, GIT, GUT not touched
– 1-5% infection rate

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2
Q

Wound Classification for the following Ex. Appendectomy, Cholecystectomy & Tonsillectomy
Thoracic lobe, hernia, Vag.
Hyster., liver transplant(txp),
gastric sx, thyroidectomy,
colon surgery, rhinoplasty

A

Clean Contaminated (Class 2)
Uninfected operative wound; respiratory, alimentary, genital, or urinary tract is entered under controlled circumstances without unusual contamination

. Primary closure
. Open/ mechanical drainage
. Minor break in sterile technique occurred
. Controlled entry to aerodigestive (includes biliary tract) or genitourinary tract
– Infection rate 8-11%

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3
Q

Wound Classification for the following Ex. Open fracture, Colon Resection with Gross Spillage of GI contents & Penetrating Trauma
Inflamed appy, bile
spillage in chole, diverticulitis, Rectal surgery

A

Contaminated (Class 3)
Acute, nonpurulent, inflamed operative wound or open, fresh wound, or any surgical procedure with major breaks in sterile technique or gross spillage from GI tract.

. Acute inflammation present
. Major break in sterile technique occurred
. Open traumatic would (less than 4 hours old) with retained necrotic tissue
. Entry to aerodigestive (includes biliary tract) or genitourinary tract with spillage
– Infected bile/urine
– Infection rate 15-20%

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4
Q

Wound Classification for the following Ex. Resection of ruptured appendix
Abscess I&D, perforated
bowel, peritonitis, wound
debridement, positive cultures pre-o

A

Dirty (class 4)
Clinically infected operative wound or perforated viscera or old, traumatic wounds with retained necrotic tissue

. Perforated viscus
– Perforated bowel, viscus, purulent inflammation, foreign body, fecal mater (e.g. Intestine)
. Microbial contamination prior to procedure
– Contamination prior to procedure (necrosis, rupture or spillage of intestinal contents)
. Open traumatic wound (more than 4 hours old)
– Infection rate 27-40%

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5
Q

When is the final wound classification assigned?

A

At the end of the procedure and is included in the intraoperative documentation

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6
Q

Intentional Wounds

A

– Chemical wounds
– Surgical incision: Intentional cut through intact tissue
– Surgical Excision: Removal of tissue

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7
Q

CLOSED WOUNDS

A

– skin is intact
- simple fractures, torn
ligaments, blister

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8
Q

OPEN WOUNDS

A

– skin is broken (sacral decubitus ulcer [bed sore])
SIMPLE – only the skin is
injured
. COMPLICATED – skin and
underlying tissues are injured
. CLEAN – cared for within 6
hours
. CONTAMINATED – cared for after 6 hours

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9
Q

ABRASION

A

– caused by rubbing or
scraping the skin

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10
Q

AVULSION

A

– portion of skin or soft tissue is partially or
completely torn away

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11
Q

CONTUSION

A

– a bruise; skin is not
broken

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12
Q

CRUSHED

A

– has been squeezed or
forced by pressure

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13
Q

INCISED

A

– made by a cutting instrument and has smooth
edges

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14
Q

LACERATION

A

– torn wound with irregular edges

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15
Q

PUNCTURE

A

– made by a sharp, pointed
instrument

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16
Q

PERFORATION

A

– made by an object
entering and exiting
the body

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17
Q

Inflammatory Process

A

. Heat (calor)
. Pain (dolor)
. Redness (rubor)
. Swelling (tumor)
. Loss of function (functio laesa)

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18
Q

First intention (primary union)

A

Happens when the wound
edges are approximated e.g.
by sutures, staples or glue.

– Lag/inflammatory response
. Injury – 3/5 day
– Proliferation
. 3rd – 20th day
. 25% - 30% strength
– Maturation /differentiation
. 14th – 12mos
. Side to side

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19
Q

Lag/inflammatory response

A

. Injury – 3/5 day

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20
Q

Proliferation

A

. 3rd – 20th day
. 25% - 30% strength

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21
Q

Maturation /differentiation

A

. 14th – 12mos
. Side to side

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22
Q

Second intention (granulation)

A

. A wound that is extensive and involves considerable tissue loss, and in which the edges cannot be brought together by sutures, heals in this manner.
Secondary intention healing
differs from primary intention healing in three ways:
- The repair time is longer.
– Large wounds
– Infected wounds
– “proud flesh” excessive
granulation

23
Q

Third intention (delayed
primary closure)

A

A method of closing a
grossly contaminated
wound in which the
wound is left open until
contamination has been
markedly reduced,
granulation has occurred
(maturation) and
inflammation has
subsided and then is
closed by first intention.

24
Q

Principles of Wound Closure

A

. Handle tissue gently
– Use toothed forceps ex: Adson
. Do not use smooth forceps
– Since these crush tissue because they
require greater pressure to grasp

25
Q

Factors affecting wound healing

A

. Post op complications
– Edema, patients with COPD
– Nosocomial infections
. Physical activity
– Early ambulation vs. Late ambulation
. Surgical technique
. Immunosuppressed status (radiation)

26
Q

Methods of preventing infection

A

. Reduce the source of contamination
– Pre-op bathing, careful pre-op shaving,
adequate use of skin prep.
.Use of Standard Precautions
. Normothermia
– Hypothermic state causes vasoconstriction
. Use of antibiotic prophylaxis
– Given 60 min. prior to surgery
. Adequate oxygenation
– Good oxygenation allows killing of bacteria via oxidation
. Use of Bowel technique during GI surgeries
. Copious irrigation
. Wound drain
. Correct dressing

27
Q

Dehiscence

A

– a surgical complication in
which a wound ruptures along a surgical incision

28
Q

Evisceration

A

– partial protrusion of the viscera through the edges of a separated wound

29
Q

Adhesion

A

– Abnormal attachment of two structures

30
Q

Herniation

A

– a condition in which part of an organ is displaced and protrudes through the wall of the cavity containing it

31
Q

Fistula

A

– Tract between two structures which is open on both ends

32
Q

Sinus tract

A

– Tract between two structures which is closed at one end

33
Q

Stitch spitting

A

– Suture spitting
– Failure in absorption of
suture

34
Q

Keloid scar

A

– Hypertrophic scar

35
Q

Cicatrix

A

– scar left by a healed wound

36
Q

Collagen

A

– Interwoven fibers, increases textile strength. White protein in connective tissue and bones

37
Q

Debridement

A

– removal of damaged
tissue or foreign
material, leaving an
open clean wound

38
Q

Disruption

A

– When the suture line breaks down, decreasing
support

39
Q

Fibrinogen

A

– Constituent of blood
that aids in
coagulation

40
Q

Granulation

A

– Formation of new
capillary tissue, scar
tissue

41
Q

Granulation tissue

A

– Fibrous connective
tissue containing blood
vessels and lymphatic

42
Q

Hematoma

A

– Tumor or swelling with clotted blood

43
Q

Hemostasis

A

– Control of bleeding

44
Q

Ischemia

A

– Decrease of blood supply to tissue (tissue approximation is too tight)

45
Q

Necrosis

A

– Death of tissue (cells)

46
Q

Proud flesh

A

– Overgrowth of
granulated tissue

47
Q

Serosanguinous

A

– Blood tinged or
colored serous drainage

48
Q

Trauma

A

– Injury to body tissue by
violence, chemical, thermal agent

49
Q

Purulent –

A
  • Containing pus
50
Q

Dead space

A

– Space that remains in tissue as a result of failure of proper wound closure

51
Q

Friable

A

– Easily ripped or
torn tissue/skin

52
Q

Eventration

A

– Protrusion of abdominal organs through the abdominal wall

53
Q

Dressings purpose for post op wound care

A
  • Protect from trauma and contamination
  • Maintain an environment Conceal the wound
  • Absorbs drainage and secretion
  • Support the incision Providing pressure

Technique ST (25 decks)

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