Soft Tissue Injuries and Healing Flashcards
What does the term soft tissues refer to
those parts which are not bone or cartilage
What type of cells remove dead tissue and clots
phagocytes
What is granulation tissue
Is it vascular
new tissue that is formed following a wound
It is highly vascular
When is primary closure usually carried out
in the first 6 hours after injury provided all foreign material and dead tissue is removed
What is secondary closure
The wound is closed after it has been allowed to granulate having overcome any sepsis
What is often necessary for secondary closure
skin graft
What is the easiest and most reliable technique for skin grafting
Partial thickness or split- skin grafting
What does partial thickness or split-skin grafting involve
Split skin (only part of the thickness of the epidermis) taken from a convenient donor site
What are full thickness detached grafts
If the dermis is included in its entirety from a donor site
What are attached skin flaps
More conventional types of full thickness grafts
Taken from one limb to another
They leave a defect at the donor site which then has to closed by split skin
What is a foreign skin graft
Taken either from animal or human
Used as a temporary dressing for large areas of loss e.g. after burns
What causes an abrasion
usually friction in trauma
What is the treatment for an abrasion
a simple protective dressing
What causes a laceration
blunt trauma
What is the treatment for a laceration
all dead and foreign material should be excised and the wound closed
X ray if there is a possibility of a foreign body
What does loss of sensation in a burn suggest
Full-thickness loss (rather than partial thickness)
What is the treatment for a partial thickness burn
They usually heal rapidly and completely
What is the treatment for a full thickness burn
The damaged tissue will slough and eventually separate or may need to be excised
Resulting wound is then closed by suture or more often skin grafting
What is the treatment for a deep wound such as a stab wound to chest or abdomen
Laparotomy or thoracotomy may be necessary to achieve an adequate exploration
What is a haematoma
collection of blood i the tissues
What is the treatment of a large haematoma
decompression or evacuation to prevent necrosis of overlying tissues
What is a contusion
the same as a bruise and consists of tissue damaged by a blow or crush
Describe the typical appearance of a low velocity gunshot wound
well circumscribed
small amount of damage
What is the treatment for a low-velocity gunshot wound
excising foreign necrotic and contaminated material
What is the treatment for a high velocity gunshot wound
Open widely Extensive debridement and decompression removal of foreign and non-viable tissue leave wound open insect surrounding tissues
How do injuries to organs arise
blunt trauma such as RTA
What is the treatment for a sprain or partial tear of a ligament
They usually heal with minimal treatment Immobilisation ice or cold water compress mobilise joint as pain subsides Physio
What is the treatment for a complete ligament rupture
apposition of the divided ends followed by a period of protection
Immobilisation for 3 weeks protection
What is the risk of surgery on no-man’s land of the hand
Tendons run within the flexor tendon sheaths and there is a tendency for adhesions to form in the sheath
How can we assess injuries to blood vessels
Angiography
What is compartment syndrome
venous outflow from a fascial compartment may may become obstructed by swelling causing the pressure to rise gradually within the compartment
What happens to the nerves in compartment syndrome
When the pressure reaches a critical level, any nerves passing through he compartment cease to function initially causing paraesthesiae followed by the loss of sensation in the area supplied by the nerve
What might happen if the pressure in compartment syndrome is not relieved urgently
the necrotic muscle may lead to the need of limb amputation
When might Compartment syndrome arise
following a closed fracture of the tibia and fibula
When does compartment syndrome arise
24-48 hours after the injury but occasionally later
What makes the pain worse in compartment syndrome
stretching the affected muscles which are also tender
What is the treatment for compartment syndrome
Splitting the deep fascia over the length of the compartment
skin is left open
all necrotic tissue must be removed
How can we judge when to decompress
use a manometric device to measure the intra-compartmental pressure
How do pressure sores arise
from continued pressure usually over a bony prominence
Where are the most vulnerable sites for pressure sores
sacrum and heels
What is the treatment for pressure sores
avoid in the first place
small sores - simple dressings after removal of sloughs
Large sores - wide surgical excision and skin grafting
How might we have to treat a patient that self inflicts injuries to their wrists
Often the person stops when they are discovered
Some time in a plaster-cast allows healing
