Surgical & Traumatic Wounds Flashcards
What are abrasions, and how are they managed?
- Abrasions are wounds caused by friction to the skin’s surface, resulting in superficial or partial-thickness injuries.
- They may or may not be contaminated.
- Management: Thorough irrigation with water or saline to remove debris, selective or nonselective debridement if needed, and application of moisture-retentive dressings (e.g., transparent film or foam).
- Contaminated wounds may require broad-spectrum antimicrobial dressings.
What are skin tears, and how are they classified?
Skin Tears result from shear or friction forces separating the epidermis from the dermis, often seen in elderly individuals with fragile skin.
- Classification Systems:
(a) ISTAP Classification:
- Type 1: No skin loss (flap repositionable).
- Type 2: Partial flap loss.
- Type 3: Total flap loss exposing the wound bed.
(b) Payne Martin Classification:
- Linear tears
- Partial-thickness tears with varying flap involvement.
- Management: Approximating wound edges, protecting with non-adherent dressings, and preventing further trauma.
What are the risks and characteristics of lacerations?
- Lacerations are wounds with little or no tissue loss, often caused by sharp objects.
- Risks include excessive bleeding (especially facial lacerations), contamination if not closed within 6 hours, and scarring.
- Management: Copious irrigation to remove debris, removal of tension at wound borders to minimize scarring, and delayed closure for contaminated wounds.
- Complex wounds may require multiple debridements or flap coverage.
How are animal and human bite wounds managed?
- Animal Bites: 80-90% are caused by dogs; risk of infection is moderate.
- Human Bites: Higher infection risk than animal bites due to polymicrobial flora, especially in closed-fist injuries.
- Management: Irrigation and debridement, short-term antiseptic use, and systemic antibiotics if infection signs appear.
- Bites must be monitored closely for signs of cellulitis or abscess formation.
What are the key differences in presentation and management of black widow vs. brown recluse spider bites?
Black Widow:
- Causes systemic symptoms (e.g., weakness, headache, hyperreflexia, tachycardia) within 1–3 hours.
- Local wound care is rarely needed; treatment involves antivenom, NSAIDs, and muscle relaxers.
Brown Recluse:
- Causes localized necrosis with a “red, white, and blue” lesion pattern (inflammation, thrombosis, ischemia) and systemic symptoms (fever, joint pain).
- Management: Debridement of necrotic tissue, moist wound healing with appropriate dressings, and monitoring for complications.
How are spider bites distinguished from abscesses?
- Abscesses, often caused by Staph infections (including MRSA), can mimic brown recluse bites but lack a clear history of a spider sighting.
- Abscesses often present with redness, warmth, swelling, and purulent drainage, while spider bites may show systemic signs like fever or malaise.
- Management of abscesses involves incision and drainage, systemic antibiotics, and protecting the wound from further contamination.
What are frostbite injuries, and how are they managed?
- Frostbite occurs due to temporary ischemia from cold exposure, causing tissue damage and potential loss, primarily in distal areas (fingers, toes).
- Management includes gradual rewarming, avoiding direct heat, maintaining moist wound healing, and monitoring for necrosis or infection.
- Severe cases may require amputation.
What are factitious wounds, and why are they challenging to manage?
- Factitious wounds are self-inflicted injuries caused by patients with underlying psychopathology or a desire for secondary gain.
- Management is challenging as patients often interfere with wound healing or deny involvement.
- A multidisciplinary approach, including psychological evaluation, is essential for effective treatment.
What interventions are used for contaminated traumatic wounds?
- Contaminated wounds should be irrigated and debrided to reduce bacterial load.
- A warm, moist wound environment is maintained using moisture-retentive dressings.
- Adjuncts like antimicrobial topicals or negative pressure wound therapy (NPWT) may be used to protect the wound and promote healing.
Why are bite wounds considered high risk for infection, and how should they be treated?
- Bite wounds, especially from humans, carry a high risk of infection due to their polymicrobial nature.
- Dog bites are moderately risky, while cat bites and human bites pose higher risks due to deeper punctures or complex flora.
- Treatment involves irrigation, debridement, and antibiotics if signs of infection (e.g., redness, swelling, warmth) appear.
- Closed-fist injuries require special attention to prevent complications.
How should traumatic wounds from motor vehicle accidents (MVAs) be managed?
- MVA-related wounds often involve contamination and concomitant injuries (fractures, head trauma).
- Management includes copious irrigation, debridement to remove debris, fracture stabilization, and maintaining a moist wound environment.
- Adjunctive therapies, like NPWT, can reduce complications in large, complex wounds.
What is the importance of moist wound healing in traumatic wound management?
- Moist wound healing maintains an optimal environment for epithelialization, reduces pain, and minimizes scar formation.
- Moisture-retentive dressings, such as transparent films or foams, are preferred for clean wounds, while antimicrobial dressings may be used for contaminated wounds.
- Overdrying a wound delays healing and increases infection risks.
What are the common complications of deep lacerations involving arteries or veins?
- Deep lacerations can lead to significant blood loss, ischemia, or necrosis if major vessels are involved. Prompt intervention includes hemostasis, copious irrigation, and assessment for viable tissue.
- If tension exists at wound edges, delayed closure or flaps may be necessary to minimize scarring and restore function.
How are traumatic wounds from industrial accidents managed?
- Wounds from industrial accidents are often complex and contaminated. Management involves thorough irrigation, debridement, fracture stabilization if necessary, and maintaining a moist wound environment.
- Antibiotics may be required for infected wounds, and tetanus prophylaxis should be considered. Rehabilitation may include physical therapy to restore function.
What is the STAR Skin Tear Classification System, and how does it guide management?
The STAR Skin Tear Classification System categorizes skin tears into three types:
- Type 1: No skin loss (edges can be repositioned).
- Type 2: Partial flap loss (edges cannot fully cover the wound bed).
- Type 3: Total flap loss (entire wound bed exposed).
- This classification helps clinicians select appropriate interventions, such as approximating edges for Type 1 tears or using moisture-retentive dressings for Types 2 and 3.
What are surgical wounds treated with primary closure, and how should they be managed?
- Surgical wounds treated with primary closure are closed using sutures, staples, or tissue adhesives.
- Management includes keeping the wound clean and dry for 24–48 hours, expecting minimal bleeding or drainage in the first few days, and monitoring for infection.
- Most surgical wounds epithelialize within 7–10 days without complications.
What factors contribute to dehisced surgical wounds, and how are they managed?
- Factors contributing to dehiscence: Malnutrition, diabetes, steroid use, smoking, excessive tension on wound edges, and underlying infection.
- Management: Reducing tension at wound borders using binders or Montgomery straps, wound irrigation, debridement, and antibiotics for infection.
- Monitoring for complications like fistulas is essential.
What are surgically debrided wounds, and how are they treated post-procedure?
Surgically debrided wounds are wounds with nonviable tissue removed to promote healing.
- Post-procedure management:
- Moisture-retentive dressings to maintain a granulating wound bed, filling dead space with packing material, and considering adjuncts like negative pressure wound therapy (NPWT) or electrical stimulation.
- Addressing systemic factors like nutrition and wound etiology is also critical.
What are flaps, and when are they used in wound care?
Flaps are tissues transplanted to cover wounds that have lost tendon, muscle, or bone.
- They are named based on their composition (e.g., osteocutaneous flap includes bone and skin).
- Local Flap: Tissue rotated while maintaining its blood supply.
- Distant Free Flap: Tissue detached and reattached with vascular connections at a new site.
- Flaps are often used for large wounds over bony prominences (e.g., sacral ulcers) or for functional restoration.
How are skin grafts used in wound management, and what are the differences between graft types?
- Skin grafts involve transplanting skin to cover wounds.
- Split-Thickness Grafts: Include the epidermis and part of the dermis; less durable and cosmetic, used for large areas.
- Full-Thickness Grafts: Include the epidermis and full dermis; more durable and aesthetic, used for smaller areas requiring strength.
- Autografts (from the patient) are preferred, while xenografts (animal) and allografts (cadaver) provide temporary coverage.
- NPWT is often used to promote graft adherence.
What are the advantages and disadvantages of rigid removable dressings in amputation management?
Advantages:
- Reduce edema, protect the residual limb, promote healing, shape the limb, and decrease pain.
- They are ideal for fall-risk patients and allow for sock adjustments to enhance shrinkage.
Disadvantages:
- Higher cost and the need for proper fitting.
- Rigid dressings are essential for preparing the residual limb for prosthetic use.
What is the role of stump wrapping in residual limb management, and what are its pros and cons?
Stump Wrapping: Reduces edema, shapes the residual limb, and promotes healing.
Advantages:
- Custom fit, adjustable tightness, and easy application over wound dressings.
Disadvantages:
- Requires skill for even compression, and wrappings may slip or loosen, leading to inconsistent results.
How does a stump shrinker differ from stump wrapping in residual limb care?
A stump shrinker is a pre-made compression garment used to reduce edema and shape the residual limb.
Advantages:
- Easy to apply and available in various sizes.
Disadvantages:
- May not compress distal areas effectively, can roll or slide on conical-shaped limbs, and is difficult to apply over dressings.
Shrinkers are more convenient for patients but less customizable than wrapping.
How are abscesses identified and treated?
- Abscesses are localized collections of purulent material caused by bacterial infections (often Staph/MRSA).
- Signs include redness, pain, warmth, and swelling.
- Treatment: Incision and drainage (I&D), irrigation, debridement, and packing to fill dead space.
- Antibiotics are used if systemic signs of infection are present.
- Protecting surrounding skin from exudate is also important.
What are the key steps in managing abscesses post-incision and drainage (I&D)?
Post-I&D management includes:
- Irrigation and Debridement: Cleaning the abscess cavity to remove debris.
- Gauze Packing: Prevents premature closure and supports drainage.
- Antibiotics: Systemic use if infection spreads.
- Wound Protection: Managing exudate and protecting surrounding skin from maceration.
What systemic complications are associated with severe brown recluse spider bites?
- Severe brown recluse bites can cause systemic symptoms like fever, malaise, joint pain, and hemolysis.
- Necrosis may extend beyond the wound site, and 3% of cases require skin grafting.
- Management includes debridement, antibiotics for secondary infection, antihistamines, and steroids.
- Systemic complications may require hospitalization.
What are the characteristics and treatment of frostbite injuries?
Characteristics:
- Frostbite causes temporary ischemia and tissue damage, primarily affecting distal areas like fingers and toes.
- Severe cases may result in necrosis or gangrene.
Treatment:
- Gradual rewarming, avoiding direct heat, maintaining moist wound healing, and monitoring for infection or systemic complications.
- Amputation may be required in advanced cases.
How do primary vs. secondary closures differ in surgical wound management?
Primary Closure:
- Wound edges are approximated using sutures, staples, or adhesives, leading to faster healing (7–10 days).
Secondary Closure:
- Wound is left open to heal through granulation, contraction, and epithelialization, often due to infection or tissue loss.
- Secondary closure takes longer but reduces infection risks in contaminated wounds.
How is negative pressure wound therapy (NPWT) used in surgically debrided wounds?
- NPWT creates a controlled vacuum over the wound bed, reducing edema, promoting granulation, and improving epithelialization.
- It is especially effective in deep wounds, wounds with dead space, and grafted areas.
- NPWT minimizes dressing changes and reduces infection risks by maintaining a sealed environment.
What is the role of nutritional support in wound healing, especially for surgical wounds?
- Adequate nutrition is critical for wound healing.
- Protein supports collagen synthesis, while calories prevent catabolism.
- Vitamins A and C, along with zinc, enhance tissue repair.
- Malnutrition can delay healing and increase the risk of dehiscence or infection.
What are the characteristics of factitious wounds, and how are they managed?
- Factitious wounds are self-inflicted injuries caused by psychological conditions or attempts at secondary gain.
- They may appear inconsistent with reported history and fail to heal due to patient interference.
- Management: A multidisciplinary approach involving wound care, psychological evaluation, and addressing underlying motives is essential.
- Education and a supportive care environment can help mitigate recurrence.
How do frostbite injuries differ in presentation and long-term outcomes based on severity?
- Mild Frostbite: Presents with reversible ischemia and redness.
- Severe Frostbite: Causes necrosis, blistering, and gangrene in distal areas (fingers, toes).
- Long-term outcomes may include tissue loss, requiring amputation.
- Effective management includes gradual rewarming, moist wound care, and monitoring for infection or systemic complications.
What are the clinical features of abscesses that differentiate them from other wound types?
- Abscesses are localized collections of purulent material presenting with redness, swelling, pain, and warmth.
- Unlike other wounds, abscesses often have fluctuance and may drain spontaneously.
- They are usually bacterial (Staph/MRSA) and require incision, drainage, irrigation, and packing.
- Surrounding skin should be protected, and systemic antibiotics are indicated for severe cases or spreading infections.
Why is monitoring for fistulas critical in dehisced surgical wounds?
- Fistulas, which are abnormal tracts connecting two epithelial surfaces, can form in dehisced wounds due to underlying infection or excessive tension.
- Monitoring is essential to detect early signs like abnormal drainage or persistent wound openings.
- Treatment includes wound irrigation, debridement, and addressing the underlying cause (e.g., malnutrition or infection) to facilitate healing.
How are large traumatic wounds managed when there is significant tissue loss?
Large traumatic wounds with tissue loss require a combination of interventions:
- Flaps or Grafts: For coverage of exposed bone, tendon, or muscle.
- Negative Pressure Wound Therapy (NPWT): Promotes granulation and wound contraction.
- Moisture-Retentive Dressings: Support a warm, moist environment for healing.
- Systemic Support: Includes adequate nutrition, infection control, and rehabilitation to restore function and mobility.
