Skin and Soft Tissue Disorders Flashcards
Wounds prone to tetanus
Longer than 6 hrs old
Deep (>1 cm) wounds
Grossly contaminated
Avulsion/puncture/crush
Tetanus vaccinations
DTap: 2, 4 and 6 months, 15-18 months and 4-6 yrs
Tdap: 11-12 yrs, then once for adults and then Td Q 10 yrs
Risk factors for impaired wound healing
Infection Smoking Malnutrition Immobilization Diabetes Vascular disease Immunosuppressive therapy
What to remember about organisms of animal bites?
Treat polymicrobially because mixture of flora of animal and human skin
Wounds seen with cat bites
Deep due to long slender teeth (or claws)
Punctures below periosteum with cat bites
May lead to osteomyelitis and septic arthritis
Categories of human bites
Occlusive wounds (intent to harm) Clenched fist or fight bites (due to teeth scraping when hit etc)
Why do you measure human bite marks?
If maxillary inter-canine distance is >2.5 cm think adult bite and child abuse
When to have surgical consult with bite wounds
Deep penetrating wounds to bones, tendons, joints or other major structures
Complex facial lacerations
Wounds associated with neurovascular compromise
Wounds with complex infections
When to use prophylactic abx with bite wounds
Deep puncture wounds
Moderate to severe wounds with associated crush injury
Underlying venous and or lymphatic compromise
Wounds on hands, genitalia, face or in close contact with bone/joint
Wounds needing closure
Compromised host
Most common cause of plantar puncture
Stepping on a nail
Management for plantar puncture
X-ray Cleansing and remove foreign body Close by secondary intent Tetanus Keep clean and warm for infection
When to x-ray with plantar puncture
Inability to visualize interior of wound Deep wounds caused by glass Pt believes there is retained object Object is small, breakable or brittle Object can be seen or felt beneath skin surface Severe wound pain Persistent localized pain over wound Painful mass or discoloration under skin Missing portion of object Injury went through rubber shoe
Indications for closure with lacerations
Extension into subQ Decrease healing time Reduce likelihood of infection Decrease scar formation Repair loss of structure or function Improve cosmesis
Contraindications for closure with lacerations
Contaminated wounds Wounds greater than 12 hrs old Presence of FB Wounds involving tendons, nerves, arteries Can't get bleeding under control
Complications of closure of a laceration
Infection Loss of function Wound dehiscence (wound ruptures along incision) Scars (keloid formation) Loss of cosmesis Tetanus
Classifications of wounds
Clean
Clean-contaminated
Contaminated
Infected
Clean wound
Surgical incisions
No involvement of GU, GI or respiratory tracts
Clean-contaminated wound
Involvement of GU, GI or respiratory tracts
Contaminated wound
Gross spillage into surgical wound (bile, stool)
Traumatic wounds
Infected wound
Established infection (I&D abscess) Gross contamination
Classification of wound closure
Primary intention
Secondary intention
Delayed primary intention
What is primary intention closure?
All layers closed
Best chance for minimal scarring
Clean/clean-contaminated wounds
What is secondary intention closure?
Deep layers closed (heals inside out)
Superficial layers left to granulate
Can leave wide scar
Requires frequent wound care
What is delayed primary intention closure?
Deep layers closed primarily
Superficial layers closed in 4-5 days after infection is not concern
Absorbable or nonabdorbable: vicryl?
Absorbable
