L5 Wound Healing and Management Flashcards
define an abrasion, how are they caused?
partial thickness, dermis still present, caused by shear force
define a puncture, how is it caused?
deep tissue injury and intro of contamination caused by sharp penetrating trauma
describe a laceration
sharp linear incision involving epidermis and dermis
describe de-gloving (incl. physiological)
wounds that involve elevation of sections of skin caused by tearing due to sheer forces
physiological: skin is lost due to interuption of vascular supply, ichaemia and necrosis 5-7 d following injury.
list the 4 wound configurations incl brief description
clean - created surgically
clean contaminated - created acutely, has bacteria
contaminated - wound w/ foreign material present
infected - wound contaminated >10^5 bacteria burden
list the 4 stages of wound healing
stage 0 - immediate response
stage 1 - inflam and debridement
stage 2 - proliferation and repair
stage 3 - remodelling/maturation
describe the processes that occur in stage 0
- formation of blood clot
- -> washes wound, releases vasoactive compounds
describe the processes that occur in stage 1, incl. timeline, cells involved, gross appearance.
- inflammation and debridement
timeline: 0-5 d
cells involved: neutrophils, macrophages
gross app: erythema, oedema, heat, pain, exudate, necrotic material, contamination - cytokines from clot regulate cellular activity , neutrophil migration followed by monocyte migration.
describe the processes that occur in stage 2: incl timeline, main cell involved, gross app
what are the 3 sub stages that occur during stage 2?
timeline: 4-12 days
imp cells: fibroblasts, endothelial cells, myofibroblast
app: gran tissue, wound closure ,
stage will not progress is foreign body still there.
a) creation gran tissue (collagen synth, vascularisation)
b) contraction
c) re-epithelisation
describe the processes that occur in stage 3: incl timeline, main cell involved, gross app
timeframe: 7-14 d
imp cell: fibroblast
gross app: scar tissue, hair growth
- type III collagen replaced w/ type I, type I fibres cross linked along lines of tension
what are some local and systemic factors that effect wound healing
local - infection - tension - necrotic/foregin material - moisture level - poor vasculature - fluid accum: O2 can't diffuse systemic - poor perfusion - hyperadrenocorticism - diabetes mellitus - immunocompromised - obesity
which wound configurations can be closed primarily?
clean wound
clean contaminated wound (need antibiotic tho)
what does primary closure of a wound require?
- suture wound edges directly
- healthy tissue
- eliminate dead space
- minimise dead space
what are some primary closure tension relieving techniques?
- pre suture
- undermining
- subcutaneous suture
- mattress suture
- releasing incisions
- reconstruction
when would you use delayed primary closure of a wound? if doing a delayed primary closure when should you close the wound? does this occur before or after gran tissue formed?
if the wound can’t be immediately closed ie/ wound contaminated or if awaiting lab results eg/ neoplasia
close within 2-5 day of wound, BEFORE gran tissue formed
does secondary closure of a wound occur before or after granulation tissue formation?
AFTER
what are the methods of surgical debridement
layered debridement - taking layers
enbloc resection - remove whole wound
lavage - application of fluid to remove contaminant , effectively diluting wound
what is the aim of secondary intention healing
aim: bandaging to provide suitable wound microenvironment to favour rapid healing
allow wound to heal fully via contraction and epithelisation before closure.
what are some examples of bandages
robert jones
modified robert jones
tie over bandage
abdominal/thoracic bandage
what are the three layers of a bandage what are their roles?
- contact layer- set microenvironment
- intermediate layer - padding and distribute forces evenly across bandage
- outer layer - coaptation, immobilisation
what are two examples of the contact layer
film
foam
list some absorbent dressings
hyper osmotic agents - honey, sugar, hypertonic saline
why is honey a good absorbent dressing?
also has antimicrobial, dehydrates bacteria and kills potentially w/ hydrogen peroxide.
describe negative pressure wound therapy:
open cell foam (400-600micron pores) adhered to wound w/ airtight plastic. tube placed attached to pump, applies negative pressure -125mmhg. sub atmospheric pressure promotes granulations, increases blood flow, re-epithelisation.
