Surgical Wound & Fracture Management Flashcards
What are wound closure techniques?
-stapling
-tissue adhesives
-suturing
-tension relieving techniques
-skin flaps
-drains
What are the surgical principles of wound management?
-gentle tissue handling
-preservation of local blood supply
-aseptic techniques
-close tissues without tension
-ensure no dead space
What are anti lick or chew methods?
-buster collar
-socks
-clothes
What are advantages and disadvantages of using staples?
-quick
-easy
-cost
-single use
-removal
What are advantages and disadvantages of using tissue adhesive (glue)?
-good for incisional wounds
-oral surgery
-easy and quick
-tissue toxicity
-infection or delayed healing
What are the 3 tension relieving techniques?
-subcuticular tissues
-waking sutures
-relaxing incisions
What techniques can be used to overcome skin tension?
-patient positioning
-would geometry
-suture patterns
-skin stretching
-tissue expanders
What are the possible complications of skin flaps?
-technical errors
-self trauma
-discharge
-necrosis
-dehiscence (wound separation)
What are free skin grafts?
-when pieces of skin are removed from a donor site and then sutured in place onto a wounds
How should free skin grafts be managed?
-immobilise the site for 5-7 days
(Normally limbs)
-careful bandage changes
-aseptic techniques
When are drains needed?
-repeated lavage of a space
-repeated aspiration of fluid or air from a space
What are passive drains?
-Penrose drain
-allows fluid to drain along the surface
-useful in high movement areas
What are advantages and disadvantages of using passive drains?
-low cost
-soft
-not ideal for large wounds
-gravity
What are active drains?
-thorax drain
-rigid tube with device that exerts constant gentle negative pressure
What are advantages and disadvantages of using active drains?
-effective
-low risk of infection
-works well with wounds
-placement
-clots
-interference
How are drains removed?
-must monitor discharge on the dressing
-passive drains require simple trim and pull
-active drains only removed when fluid production decreases
What is indirect fracture healing?
-clotting
-granulation tissues stabilise fractures and allows cartilage to develop a callus
What is direct fracture healing?
-bone edges so close together that callus doesn’t form
-requires surgery
What are influencing factors on healing time?
-geriatric
-kidney failure patients
-weakened bones
-poor blood supply
-the of fracture
-poor fixes
-movement
What are the principles of fracture repair?
-restoring length
-restoring functional shape
-maintaining soft tissue function
What are the 3 fixation techniques?
-external coaptation
-internal fixation
-external skeletal fixation
What is external coaptation?
-casts and splints
-limits motion of fracture sight
-immobilises joint above and below fracture sight
What are advantages and disadvantages of using external coaptation?
-simple
-non invasive
-not sufficient stabilisation
-decubital ulcers
-slow healing
What are the 4 methods of internal fixation?
-pins
-plates
-screws
-wires
What are advantages and disadvantages of using internal fixation?
-used for closed fractures
-easy return to full function
-expensive
-time consuming
-requires skill and special equipment
What is external skeletal fixation?
-pins are inserted through a small stab incision into skin then into bone
-fixed on outside with bars and clamps
What are advantages and disadvantages of using external skeletal fixation?
-minimal instruments required
-adjustable
-easy to assess
-easy removal
-requires skill
-premature pin loosening
What factors affect fracture repair choice?
-classification of fracture
-age
-size
-temperament
-underlying conditions
-cost
-owner expectations
