Plastic wound healing

Question 1

What are the stages of wound healing?

Answer 1

4 stages

1. Haemostasis
2. Inflammation
3. Proliferation
4. Remodelling

Question 2

How long does epithelialisation take?

Answer 2

48hrs if 2 pieces of skin are cut and left to heal side by side

Question 3

What happens during haemostasis?

Answer 3

Vasoconstriction
platelet aggregation
clotting cascade
fibrin deposition

Question 4

What happens during days 1-4 of wound healing?

Answer 4

Inflammation stage

• chemotaxis attracts neutrophils on days 1 and 2
• macrophages arrive days 2-4
• epithelialisation begins

Question 5

What happens over the first 3 weeks of wound healing?

Answer 5

Proliferation D4 - wk 3

• fibroblast proliferation
• ongoing angiogenesis
• ongoing epithelialisation

Question 6

When does remodelling of a wound occur

Answer 6

from week 3 onwards

• collagen synthesis and breakdown occurs
• there is scar contraction
• after 60 days from wound injury the the scar will be at 80% of its pre-injury strength

Question 7

What are the factors that affect wound healing?

Answer 7

There are local factors and general factors.
Local factors ; blood supply/ischaemia, infection, foreign body, haematoma, mechanical facets e.g. tension, previous radiation
General factors: smoking, chronic disease, steroid use, nutritional deficiencies, age, genetics

Question 8

What is the difference between primary closure and secondary intention?

Answer 8

In primary closure the 2 edges are left together to heal as linear scar. In secondary intention the edges are not opposed together and the wound heals from the edges in by a combination of epithelialisation and contraction.

Question 9

Which takes longer, healing by primary closure or secondary intention?

Answer 9

Secondary intention

Question 10

What are the features of an ideal scar?

Answer 10

Flat
Thin
Colour match
Orientated along the relaxed skin tension lines

Question 11

Types of abnormal scarring

Answer 11

Hypertrophic and keloid scars

Question 12

What is the difference between a hypertrophic scar and a keloid scar?

Answer 12

Hypertrophic scars are elevated, red, enlarged scars that form within the borders of the original scar.
Keloid scars are elevated, raised, enlarged scars extending beyond the boundary of the original scar

Question 13

What is the treatment of abnormal scars

Answer 13

pressure garments
silicone sheeting
steroid injections
re-excision

Question 14

what skin type is more prone to keloid scar formation?

Answer 14

Darker skin groups

Question 15

What is the primary goal of wound management?

Answer 15

To obtain a closed wound as quickly as possible to prevent infection and secondary deformity

Question 16

what is surgical debridement?

Answer 16

Converting a chronic dirty contaminated wound into an acute clean fresh wound

Question 17

Characteristics of an ideal dressing

Answer 17

Maintain a moist environment at the wound interface
Remove exudate
Act as a barrier to micro-organisms
Be easy to remove without trauma to the wound
Leave no foreign particles in the wound

Question 18

Steps on the reconstructive ladder

Answer 18

Secondary intention 
Primary closure
Delayed primary closure
Skin grafts
Local flap
Regional flap
Free flap

Question 19

What is a skin graft

Answer 19

Segment of skin detached from its blood supply at the donor site and dependent upon revascularisation from the recipient site

Question 20

Difference between split and full thickness skin grafts

Answer 20

Split is epidermis and some dermis

Full is all epidermis and dermis

Question 21

Type of donor healing with a split thickness skin graft

Answer 21

Donor heals by epithelialisation

Question 22

Type of donor healing with a full thickness skin graft

Answer 22

Donor closed primarily

Question 23

What type of skin graft is better for large areas?

Answer 23

Split thickness

has less primary contraction

Question 24

which skin graft is used for face?

Answer 24

Full for face and hends because better cosmesis

Question 25

What is the purpose of meshing a skin graft?

Answer 25

increases the area the graft can cover and allows evacuation of any fluid that could build up

Question 26

Factors needed for a graft to take

Answer 26

the graft bed must be

• well vascularise ( not bone, cartilage or tendon)
• good contact ( no haematoma or shearing)
• clean

Question 27

steps of a graft taking

Answer 27

Adherence
Serum imbibtion
Revasularisation, Inosculation, neovascular ingrowth
Remodelling

Question 28

A lat dorsi flap is an example of what type of flap

Answer 28

Axial regional

Question 29

How is a flap different to a graft

Answer 29

A flap is Tissue transferred from one site to another with vascular supply intact ( not reliant on revascularisation from the recipient site like a graft is)

Question 30

What needs to be checked on a flap post op

Answer 30

Colour
Temp
Cap refill 
Soft v tense
Doppler

Question 31

What are the signs of arterial insufficiency post op on a flap

Answer 31

Pale, cool, may or may not have arterial pulse on doppler. Decreased turgor

Question 32

What are the signs of arterial insufficiency post op on a flap

Answer 32

Purple/ blue
warm of cool
may or may not have doppler arterial pulse
Increased turgor

Question 33

Contraindications for using VAC dressing

Answer 33

• Exposed vital structure (organ / vessel or vascular graft)
• ongoing infection
• devitalised / alignent tissue
• adhesive allergy

Question 34

What type of dressing is VAC

Answer 34

A closed system