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.
