SOFT TISSUE SX: wound management Flashcards
what are the 3 phases of wound healing
1- inflammation
[inflammatory and debridement phase]
2-proliferation
3-maturation
Sutures are removed during which phase of the wound healing process?
phase 2-proliferation
Which phase has the most gain in wound strength?
maturation
What are 3 characteristics of the inflammatory phase?
hemorrhage & clot formation ,,,,increase blood flow ,,,,,start to control bacterial infection
Which 2 types of cells will become present during the inflammatory phase?
What are their functions?
neutrophils [phagcytose bacteria & die]
macrophages [phagocytose debris, produce proteases, release cytokines]
What are 2 characteristics of the proliferative phase?
granulation tissue formation &
epithelialisation
Describe the difference between healthy and unhealthy granulation tissue
H: resistant to infection, red, moist, flat, nutrient and oxygen supply, lattice for scar formation
UH: pale, not progressing, necrotic debris or infection
What are a 5 factors that promote epithelialisation?
healthy granulation bed
absence of infection
‘’ ‘’ necrotic debris
oxygen at wound surface (vessels)
moist wound
What are 2 characteristics of the maturation phase?
scar contraction and collagen remodelling
What are the two types of factors affecting wound healing
give 5 examples of each
host factors:
-old age
-hypoalbuminemia
-endocrine disorders
-metabolic disease
-medication
local factors:
-foreign material
-infection
-trauma
-desiccation
-hypoxia
What are the 4 types of wound closure options available
briefly describe the differences in closures and when they wound be used
primary [immediate surgical closure of healthy wounds]
delayed primary [moderate tissue trauma by dirty objects, closure after bacteria and debris is eliminated but before granulation starts]
secondary [closure once granulation tissue has formed]
second intention [inflammation –>proliferation –>maturation]
What are the 3 steps to open wound management?
- initial assessment n preparation
- debridement
- granulation
What are techniques to assist with initial assesment and preperation?
-prevent further contamination (asepsis, sterile dressing, clip widely)
-lavage to remove contaminants
Describe debridemment and devitalised tissue
-sharp dissection/ scraping with blade/ rubbing with dry swab for compromised tissue
-devitalised tissue: white, green, black, does not bleed when nicked
How often is dressing changed during debridement?
every 12-24 hours/before dressing is satirated
When should dressing be changed to non-adherent?
when all necrotic tissue is removed, exudate remains, and granulation starts
What is autolytic debridement?
What type of wound dressing is used during the granulation phase?
non-adherent dressing
ex-hydrocellular foam dressing
What is the major aim of the granulation phase?
achieve moist wound environment
What are some benifits of using hydrogel in wound care?
fits irregular wounds well and prevents adherence of a second layer
What are some characteristics of healthy granulation tissue?
-red
-uniform
-minimal exudate
-progressing daily
-no significant bacterial infection
-good blood supply
-no devitalised tissue
-no foreign material
What are the 3 layers of bandages and their functions?
- primary (contact) layer
- intermediary layer [holds contact layer in place, absorb exudate, padding, support, analgesia]
- tertiary layer [conforming/cohesive, apply pressure, protect from environmental contamination]
Are antibiotics indicated in traumatic/open wounds?
yes
What are two examples of topical antimicrobials in wound care?
-silver dressings
-honey dressings
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name 7 halstead principals
1 strict aseptic technique
2gentle tissue handling
3meticulous haemostatis
4 preservation of blood supply
5obliteration of dead space
6 accurate apposition of tissue
7minimise tension
What are stay sutures?
temporary sutures used to manipulate tissue during an operation
How should the panniculus be treated in order to preserve blood supply?
if panniculus is present: create it as a flap and move to the side, dissect below [panniculus has blood supply, you want it to be intact]
if panniculus is absent: continue dissection as normal
What are some techniques to reduce tension in a wounds?
-distribute tension evenly through all wound layers
-follow tension lines
-tension relieving suture patterns
-reconstructive techniques (flaps/grafts)
What is the primary tension holding layer of the wound?
subcutaneous
Should wounds be closed parallel or perpendicular to tension lines?
parallel
What is undermining?
What is an advantage and disadvantage of undermining?
undermining seperates dermal layer from below connective layers
advantage: tension relief
disadvantage: increases dead space
What are walking sutures?
absorbable, simple interrupted sutures that distribute tension throughout wound
What is the name of this type of tension relieving sutures
mattress sutures
What is the name of this type of tension relieving sutures
relaxing incisions
What is the name of this wound closing defect?
dog ears
What is the name of this wound closure irregular defect?
centripetal closure/geometric wound closure
What are two types of pedicle flaps?
Decribe the two types of pedicle flaps and their difference?
axial pattern flaps: uses a direct cutaneous vessel
What are some advantages and disadvantages of a free skin graft?
advantages: applicable to distal extremity
disadvantages: no vascular supply, expensive, healthy granulation bed required, must develop blood supply form wound bed, intolerant of movement
