Surgical wound

Question 1

What is a fistula?

Answer 1

Connection between two epithelial structure

Question 2

What is a Marjolin’s ulcer?

Answer 2

Aggressive squamous cell carcinoma that develops from a non-healing wound

Question 3

What are the main stages of wound healing?

Answer 3

1. Haemostasis - (mins-hours). Clot formation
2. Inflammation (1-5 days) as neutrophils migrate to wound. Growth factors released
3. Regeneration (weeks) fibroblasts produce collagen and angiogenesis occurs due to VEGF
4. Remodelling (months-year) Myofibroblasts cause wound contraction, microvessels regress leaving a scar

Question 4

What are some preventative factors for wound infection?

Answer 4

• Smoking cessection,
• Glucose control,
• Optimisation co-morbidities
• Antibiotic prophylaxis,
• Delayed wound closure,
• Shaving skin
• Skin antiseptic
• Avoid diathermy overuse
• Remove dead tissue

Question 5

What factors can impeed wound healing?

Answer 5

Local - Infection, poor blood supply, increased skin tension, foregine bodies
Systemic - High glucose, steroids, poor nutrition, elderly, cancer, nutritional deficiency, immunosupression and radiotherapy

Question 6

What is involved in a wound assessment?

Answer 6

Size and site, edge of wound, wound bed, infection and surrounding skin

Question 7

What is slough?

Answer 7

Collection of dead white cells, fibrin, cellular debris and dead tissue. Normal part of wound healing but can act as nutrition source for bacteria

Question 8

What is granulation tissue?

Answer 8

Bright red, moist and bumbpy tissue. Occurs when fibroblasts differentiate into myofibroblasts

Question 9

What are some management techniques for surgical wounds?

Answer 9

• Control bleeding,
• Clean wound with: disinfecting surrounding skin, irrigate with saline, debride dead tissue and abx.
• Analgesia
• Skin closure
• Dressing and follow up - Tetanus, anx, worsening advice, keep wound dry

Question 10

What is wound dishiscence

Answer 10

Separation of wound, often abdominal wounds

Question 11

What are risk factors for wound dehiscence?

Answer 11

• Poor surgical techniques,
• Increased intra-abdominal pressure (coughing, vomiting or constipation)
• Wound infection
• Protein malnutrition
• Obesity and smoking
• Steroids and chemo

Question 12

What are the investigations for wound dehiscence?

Answer 12

• Swabs for cultures,
• Bloods
• Ultrasound or CT
• Physical exam

Question 13

What is the management of wound dehiscence?

Answer 13

1. Immediately cover the wound with sterile gauze soaked in saline
2. Transfer patient to theater
   - Initiate systemic abx
   - Address underlying issues