Minor Surgery 1 Wk 6

Question 1

Understand the concept of Langer’s Lines. What are “two” advantages of using this knowledge when doing minor surgery?

Answer 1

Direction of the natural orientation of collagen fibers in the dermis. Aka cleavage lines. Advantages: minimize scars, incisions heal faster.

Question 2

What are the “problem areas” of the body for increased risk of scarring/keloids?

Answer 2

Incisions across Langer’s lines: Upper chest and back/shoulders

Question 3

How do Kraissl’s lines compare to Langer’s Lines?

Answer 3

Kraissl’s: defined based on observations in living people. Langer’s: defined in cadavers.

Question 4

When a wound occurs what, essentially, is the body’s only interest?

Answer 4

Only interested in survival of the organism – not how great the healed lesion looks or if 100% function is restored.

Question 5

Be able to list and describe (what is occurring in each stage) of the three phases of healing

Answer 5

a) Inflammatory: Immediate to 2-5 days; bleeding stops (constriction, platelet aggregation, scab formation); Inflammation (increased blood supply and cleansing of wound)
b) Proliferative: 5 days to 3 weeks; Granulation (new collagen laid down, new capillaries fill in defect); Contraction (wound edges pull together); Epithelialization (Cells cross over the moist surface, cells travel about 3 cm from pt of origin)
c) Maturation: 3 weeks- 2 yrs; collagen forms which increases tensile strength; scar tissue is only 80% strong as original tissue

Question 6

What is the average tissue strength of a healing wound when the sutures are removed at 10-14 days?

Answer 6

5-6%

Question 7

Understand the difference between clean, clean-contaminated, dirty/contaminated and infected wounds.

Answer 7

Clean: free of microorganism – sterile conditions (heart surgery)
Clean-contaminated: non-significant contamination and less than 6 h elapsing until medical care (biliary and gastric surgeries)
Dirty/Contaminated: Without local infection and more than 6 h elapsing until medical care (colon surgeries)
Infected: Intense Inflammatory reaction and frank infectious process (appendicitis and cholecystitis)

Question 8

Is there a “Golden Period” of time for closing lacerations?

Answer 8

Not anymore, in the past wounds weren’t closed if they occurred 8 hours prior (on the body) or over 12-24 on the face.

Question 9

What factors involving the patient and surgeon affect wound repair?

Answer 9

Patient’s responsibility: overall health status will affect procedure and outcome. Surgeon’s responsibility: aseptic and quality technique in suturing etc.

Question 10

Understand the concept of “Healing by First (Primary) Intention”. What are the goals and outcomes of this method?

Answer 10

Clean wound, closed promptly, minimal edema, no local infection, no serious discharge, heals in minimal time, good skin approximation, minimal scarring.

Question 11

What are the two possibilities that lead to a wound “Healing by Secondary Intention”? Can it be a reasonable choice made by the patient or surgeon? What are its advantages and disadvantages?

Answer 11

Scenario 1) wound failed to heal by primary intention. Scenario 2) choosing to leave wound open on purpose. Yes, it can be a reasonable choice depending on circumstances. Advantages: simplicity. Disadvantages: takes a long time to heal, leaves increased scar size.

Question 12

Describe the steps in “Delayed Primary Closure (DPD)”. When should it be used?
What are its advantages?

Answer 12

Aka Third intention. Steps: 1) debride 2) leave wound open 3) pack the wound 4) cover with bandage – repeat daily. 5) when healthy granulation tissue develops draw granulated surfaces together (between 4-6 days) 6) carefully approximate the skin edges and underlying tissues with sutures. Recommended for heavily contaminated wounds. Advantages: Uncomplicated closure with low risk of infection and a “reasonable” scar.

Question 13

What are the advantages of using a “running” stitch? Where on the body is this a good stitch to use?

Answer 13

Convenient, rapid sutures; faster to perform; equal tension to wound edges for good eversion on edges. Use on: eyelids, neck, scrotum, or wherever skin is loose.

Question 14

What are the four “Goals of Surgery”?

Answer 14

1. Close the wound efficiently 2. No infection occurring during
   the healing process.
2. End up with a small scar that is
   as inconspicuous as possible
3. No loss of function.
   Only a portion of these goals are within our ability as a surgeon to control; a portion is dependent upon the patient.