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Surgery > Surgical Wound Healing > Flashcards

Surgical Wound Healing Flashcards

1
Q
  • Involves epidermis and dermis w/o total penetration of dermis
  • minimized scarring
  • most surgical wounds healed by this
A

Primary Intention

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2
Q
  • wound allowed to granulate
  • process slowed by drainage from infection
  • leaves big scar
A

Secondary Intention

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3
Q
  • delayed primary closure
  • wound cleaned, debrided, and observed 4-5 days prior to closure
  • wound purposely left open
A

Tertiary intention

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4
Q

What hormone is decreased in response to injury?

A

TSH

-everything else is increased

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5
Q

What happens in the early phase of metabolic response to injury?

A
  • dec body cell mass
  • VASOCONSTRICTION -to conserve volume
  • change in energy source
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6
Q

What are the stages of tissue healing?

A
  1. inflammation
  2. repair/fibroblastic
  3. remodeling
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7
Q

what factors are involved in the vascular and inflammatory phase?

A
  • subendothelial factor VII
  • hageman fator xii
  • platelet derived growth factor
  • histamine
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8
Q

what process is critical for a wound to be considered ‘healed’?

A

re-epithelization phase

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9
Q

what is the initial event of re-epithelization

A

-migration of undamaged epidermal cells from the wound edges

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10
Q

what is important for the migration of undamaged epidermal cells from wound margins?

A

water content because cells seek level of critical humidity

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11
Q

why do ulcers have a HPK rim?

A

there is increase in epithelial proliferation at wound margins

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12
Q

What is this?

  • crosslinks with fibrin to provide matrix for cell adhesion and migration
  • promotes phagocytosis
  • forms scaffolding for collagen deposition
A

-Fibronectin

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13
Q

What is granulation tissue made up of?

A
  • inflammatory cells
  • fibroblasts
  • new vasculature in hydrated matrix of glycoproteins
  • collagen
  • GAGs
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14
Q

What factors are involved in fibroplasia and matrix formation?

A

EGF-epidermal growth factor
MDGF-macrophage derived
PDGF-platelet derived

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15
Q

what are the processes of fibroplasia and matrix formation?

A
  • differentiation of myofibroblast
  • fibronectin crosslinks
  • migration of myofibroblast
  • type 3 collagen fibers on scaffold
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16
Q

what contracts in wound contraction?

A

-myofibroblasts and the attached surrounding tissue “fibronexus”

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17
Q

What is a fibronexus?

A

-intimate association between the membrane of myofibroblasts, intracellular actin and extracelluar fibronectin

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18
Q

What factors are involved in neovascularization?

A
  • Fibronectin

- macrophage derived angiogenic factor

19
Q

What is the initial event of neovascularization?

A

directed migration of endothelial cells

20
Q

What is the process of neovascularization

A
  • fragmentation of venule basement membrane
  • endothelial cells develop pseudopodia
  • pseudopodia protrude through the disrupted BM
  • entire cell migrates into the perivascular space

-these are stimulated by hypoxic conditions

21
Q

What factors are involved in matrix and collagen remodeling?

A

iron, copper, vitamin c

22
Q

Processes of matrix and collagen remodelling?

A

Fibroblasts->procollagen->collagen

  • collagen crosslinking
  • fibronectin disappears
  • water reabsorbed to allow collagen fibers to lie closer together
  • Type 3 collagen replaced by type 1 collagen
23
Q

Why is it important to manage your deadspace?

A

because it can fill with bacteria and cause hematoma formation

24
Q

what is the consequence of ischemic tissue?

A

-decreases: cell proliferation, resistance to infection, and collagen production

25
Q

What deficiency causes this?

-slow re-epithlization, decreased collagen synthesis, increased infection

A

vitamin a

26
Q

What deficiency causes this?

-unstable collagen produced

A

vitamin c

-essential co-factor for collagen synthesis

27
Q

which vitamin deficiency coincides with deficiency of clotting factors 2,7,9,10 and increased chance of hematoma

A

vitamin k

28
Q

what deficiency causes this?

  • impaired immune responses, decreased protein and collagen synthesis, interference with vitamin a transport
  • dna/rna polymerases
A

zinc

29
Q

What type of sutures are these?

  • poly amide (nylon)
  • poly ester (dacron)
  • poly propylene (prolene)
A

synthetic non-absorbables

silk linen is a natural non-absorbable

30
Q

what type of sutures are these?

  • poly glactin (vicryl)
  • poly glycolic acid (dexon)
  • polyglyconate
A

synthetic absorbable

-catgut is natural absorbale

31
Q

what are the characteristics of absorbable sutures?

A
  • subq tissue
  • eliminate dead space
  • minimize tension on wound edges
  • may spit if placed too superficially
32
Q

-type of suture-

  • absorbable braided synthetic
  • homopolymer of glycolic acid
  • hydrolytically absorbed
  • good tensile str, excellent knot security
  • 2 week duration, 65% of tensile str remains
A

Polyglycolic acid

-Dexon

33
Q

-type of suture-

  • synthetic heteropolymer
  • braided, multifilament, coated
  • hydrolytically absorbed
  • stronger than dexon
  • can be impregnated with antibiotic triclosan
A

Polyglactin

-vicryl

34
Q

-Type of suture-

  • absorbable synthetic
  • monofilament; glycolic acid and trimethylene carbonate
  • 75% of original str at 2 weeks
A

Polyglyconate

-maxon

35
Q

characteristics of non-absorbable sutures

A

used on skin

  • deep suture to provide prolonged mechanical support
  • should be tight enough to approximate not strangulate tissues
36
Q

-type of suture-

  • monofilament, dyed or undyed
  • isotactic crystalline stereoisomer of polypropylene
  • BLUE
A
  • polypropylene

- prolene

37
Q

which suture has lots of memory and lots of knot slippage

A

Nylon

38
Q

which suture technique is used for longer wounds?

  • very strong
  • easier to evert edges
  • less time consuming
  • easier to strangulate skin edges
A

Horizontal mattress

39
Q

Which suture is good for deep wounds?

  • aids in reapproximation of deep tissue
  • pretty good for keeping tension off skin edges
  • harder to evert skin edges
A

Vertical mattress

40
Q

Which suture is used to take tension off the skin edges and provide deeper and wider support to the healing incision

-hard to evert skin edges

A

retention sutures

41
Q

which suture technique leaves a pretty to absent scar if done correctly and has a high rate of dehiscnece if not done properly?

A

subcuticular suturing

42
Q

what is the treatment for hypertrophic scars?

A

cortisone injections

  • decreases the level of collagenase inhibitors and increase collagen degradation
  • kenalog 40 directly into the scar
43
Q

when do you remove dorsal, medial, or lateral sutures?

and when do you removed plantar sutures?

A

14 days

21 days

Surgery (9 decks)

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