Open Wounds

Question 1

Which of the following is false?
• An abrasion is a partial thickness epithelial injury typically resulting from blunt trauma or shearing force
• Puncture wound is due to penetration of an object into the tissues causing deep tissue contamination and damage
• A laceration is characterized by extensive loss of skin and underlying tissue of the wound bed
• A decubitus ulcer results from compression of skin and soft tissue between bony prominences and a hard surface

Answer 1

C

Question 2

Which of the following is true?
A Colonization is defined as invasion and replication of microbes within tissue
B Class 1 wounds are 6-12 hours old
C Class 3 wounds are greater than 12 hours old and are more likely to be infected
D 10^11 colony forming units per gram of tissue is needed for tissue to become infected

Answer 2

C true
A colonization = when surface microbes are replicating
D 10^5  CFY = infected
better to think #microbes x virulence/ host resistance
?
Class 1: clean
Class 2: clean contaminated
Class 3: contaminated
Class 4: dirty

Question 3

Which of the following is false?
A Class I wounds can be treated with primary wound closure
B Delayed primary closure must occur before granulation tissue develops
C Secondary closure (or 3rd intention healing) must occur before 3-5 days after wounds
D Second intention healing involves healing via contraction and epithelialization

Answer 3

C false- occurs later after granulation tissue 4-5 days

Question 4

Which is true?
• Detection of a positive tissue culture result is inconsistent with the definition of wound infection.
• Cultures from swabs of the exudate or surface of a wound are representative of the infective organism.
• Acute wound infections are usually the result of one dominating microorganism.
• Chronic wound infections treatment involves prolonged administration of narrow-spectrum antimicrobials and usually favors development of resistant microorganisms.

Answer 4

C true acute wounds = one dominating organism

Question 5

Which of the following is true?
• Cytotoxic antiseptics should be used to flush, for example 0.5% chlorhexidine and 1% povidon-iodine
• The intent of debridement is to have a well-vascularized wound bed to support healing
• Enzymatic debridement is best for acute wounds that are heavily contaminated
• Enzymatic debridement is nonselective and works by hyperosmosis, like hypertonic saline

Answer 5

B

A 0.05-0.1% chlorhex and 0.1-0.01% iodine

Enzymatic agents used in inflammatory/debridement/early repair: adjunct to sx debridement, superficial debridement of poor granulation in chronic wounds
(collagenase)

Question 6

True or false: Honey has multiple possible modes of action including hyperosmolality, hydrogen peroxide production, phytochemicals, and antioxidants.

Answer 6

true

Question 7

True or false: Maggots of the green blow fly will not destroy healthy tissue.

Answer 7

false They will destroy healthy epithelium

Question 8

Early repair and proliferation of fibroblasts and endothelial cells occurs in __ to __ days

Answer 8

3-5 d

Question 9

Sufficient granulation bed in a full thickness wound (usually _____ days after wounding)

Answer 9

4-5 d

Question 10

What is the difference between anatomic and physiologic degloving

Answer 10

Anatomic skin is ALSO torn off, physiologic skin intact but avulsed

Question 11

What pressures are used for VAC on a wound for gauze and foams based systems?

Answer 11

• 80mm Hg for gauze

- 125 for foam

Question 12

What are the 4 wound healing phases in order?

Answer 12

Inflammation
debridement
repair
maturation

Question 13

What pH is honey effective in?

Answer 13

3.2-4.5

acidic

Question 14

What is the inhibin number? (think %)

Answer 14

amount of dilutation to which honey will retain antibacterial activity

Question 15

What VAC pressure should be used over a graft?

Answer 15

-65 to -75