Soft Tissue Injuries and Healing

Question 1

What does the term soft tissues refer to

Answer 1

those parts which are not bone or cartilage

Question 2

What type of cells remove dead tissue and clots

Answer 2

phagocytes

Question 3

What is granulation tissue

Is it vascular

Answer 3

new tissue that is formed following a wound

It is highly vascular

Question 4

When is primary closure usually carried out

Answer 4

in the first 6 hours after injury provided all foreign material and dead tissue is removed

Question 5

What is secondary closure

Answer 5

The wound is closed after it has been allowed to granulate having overcome any sepsis

Question 6

What is often necessary for secondary closure

Answer 6

skin graft

Question 7

What is the easiest and most reliable technique for skin grafting

Answer 7

Partial thickness or split- skin grafting

Question 8

What does partial thickness or split-skin grafting involve

Answer 8

Split skin (only part of the thickness of the epidermis) taken from a convenient donor site

Question 9

What are full thickness detached grafts

Answer 9

If the dermis is included in its entirety from a donor site

Question 10

What are attached skin flaps

Answer 10

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

Question 11

What is a foreign skin graft

Answer 11

Taken either from animal or human

Used as a temporary dressing for large areas of loss e.g. after burns

Question 12

What causes an abrasion

Answer 12

usually friction in trauma

Question 13

What is the treatment for an abrasion

Answer 13

a simple protective dressing

Question 14

What causes a laceration

Answer 14

blunt trauma

Question 15

What is the treatment for a laceration

Answer 15

all dead and foreign material should be excised and the wound closed
X ray if there is a possibility of a foreign body

Question 16

What does loss of sensation in a burn suggest

Answer 16

Full-thickness loss (rather than partial thickness)

Question 17

What is the treatment for a partial thickness burn

Answer 17

They usually heal rapidly and completely

Question 18

What is the treatment for a full thickness burn

Answer 18

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

Question 19

What is the treatment for a deep wound such as a stab wound to chest or abdomen

Answer 19

Laparotomy or thoracotomy may be necessary to achieve an adequate exploration

Question 20

What is a haematoma

Answer 20

collection of blood i the tissues

Question 21

What is the treatment of a large haematoma

Answer 21

decompression or evacuation to prevent necrosis of overlying tissues

Question 22

What is a contusion

Answer 22

the same as a bruise and consists of tissue damaged by a blow or crush

Question 23

Describe the typical appearance of a low velocity gunshot wound

Answer 23

well circumscribed

small amount of damage

Question 24

What is the treatment for a low-velocity gunshot wound

Answer 24

excising foreign necrotic and contaminated material

Question 25

What is the treatment for a high velocity gunshot wound

Answer 25

Open widely 
Extensive debridement and decompression 
removal of foreign and non-viable tissue 
leave wound open 
insect surrounding tissues

Question 26

How do injuries to organs arise

Answer 26

blunt trauma such as RTA

Question 27

What is the treatment for a sprain or partial tear of a ligament

Answer 27

They usually heal with minimal treatment 
Immobilisation 
ice or cold water compress 
mobilise joint as pain subsides 
Physio

Question 28

What is the treatment for a complete ligament rupture

Answer 28

apposition of the divided ends followed by a period of protection
Immobilisation for 3 weeks protection

Question 29

What is the risk of surgery on no-man’s land of the hand

Answer 29

Tendons run within the flexor tendon sheaths and there is a tendency for adhesions to form in the sheath

Question 30

How can we assess injuries to blood vessels

Answer 30

Angiography

Question 31

What is compartment syndrome

Answer 31

venous outflow from a fascial compartment may may become obstructed by swelling causing the pressure to rise gradually within the compartment

Question 32

What happens to the nerves in compartment syndrome

Answer 32

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

Question 33

What might happen if the pressure in compartment syndrome is not relieved urgently

Answer 33

the necrotic muscle may lead to the need of limb amputation

Question 34

When might Compartment syndrome arise

Answer 34

following a closed fracture of the tibia and fibula

Question 35

When does compartment syndrome arise

Answer 35

24-48 hours after the injury but occasionally later

Question 36

What makes the pain worse in compartment syndrome

Answer 36

stretching the affected muscles which are also tender

Question 37

What is the treatment for compartment syndrome

Answer 37

Splitting the deep fascia over the length of the compartment
skin is left open
all necrotic tissue must be removed

Question 38

How can we judge when to decompress

Answer 38

use a manometric device to measure the intra-compartmental pressure

Question 39

How do pressure sores arise

Answer 39

from continued pressure usually over a bony prominence

Question 40

Where are the most vulnerable sites for pressure sores

Answer 40

sacrum and heels

Question 41

What is the treatment for pressure sores

Answer 41

avoid in the first place
small sores - simple dressings after removal of sloughs
Large sores - wide surgical excision and skin grafting

Question 42

How might we have to treat a patient that self inflicts injuries to their wrists

Answer 42

Often the person stops when they are discovered

Some time in a plaster-cast allows healing