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ACVN - SURGICAL NURSING > Surgical Wound Reconstruction > Flashcards

Surgical Wound Reconstruction Flashcards

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1
Q

what can secondary intention healing lead to?

A

contractures which require revision and can be painful

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2
Q

what are the advantages of simple suturing?

A

simple, quick and easy

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3
Q

what are simple sutures most appropriate for?

A

primary and delayed primary closure e.g fresh wound, clean or clean/contaminated, site and size of wound not too big or not too much skin loss

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4
Q

what are subdermal plexus flaps?

A

skin can be advanced in a straight line or can be rotated into place depdning where the wound is and where the skin tension is on the patient, used advantages of small veins and arteries due to elasticity

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5
Q

what are the two types of subdermal skin flaps?

A
  • Flank fold flap for inguinal wounds
  • Elbow fold flap for axillary wounds
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6
Q

what are the advantages of doing a subdermal plexus flap?

A
  • Simple yet versatile
  • Good for medium-sized wounds
  • Reduces tension
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7
Q

what are the disadvantages of doing a subdermal plexus flap?

A
  • Relies on accurate wound assessment
  • Has size limitations
  • Damage to plexus possible
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8
Q

what are subdermal plexus flaps most appropriate for

A
  • fresh wounds
  • clean is primary surgery
  • contaminated/dirty if surgery delayed primary or secondary
  • site and size of wound medium sized wounds
  • surgical debridement
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9
Q

what does an axial pattern flap do?

A

Incorporate a direct cutaneous artery and vein capable of providing blood to large areas of skin that can then be ‘raised’ and moved to cover large defects with less
chance of breakdown due to vascular necrosis

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10
Q

what are the advantages of doing an axial pattern flap?

A
  • Come with good blood supply
  • Longer and wider flaps possible than subdermal
  • Can offer rapid healing of chronic wound
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11
Q

what are the disadvantages of doing an axial pattern flap?

A
  • Steep learning curve
  • Flap necrosis could be catastrophic
  • Good post-op care vital
    +/- Cosmetic result
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12
Q

what are the disadvantages of doing a free skin graft?

A
  • Needs a healthy bed of granulation tissue
  • Needs some skin to ‘grow’ into that tissue
  • Lower success rates
  • Steep learning curve
  • Requires a healthy granulation bed
  • Requires a talented surgeon, committed nursing team, committed owner
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13
Q

what two types of free skin grafts can be done?

A
  • Sheet => have to close the donor site as a primary wound (make involve
    subdermal plexus flap)
  • Punch (biopsy punch)
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14
Q

what are the advantages of doing free skin graft?

A
  • Punch grafts simple
  • Sheet grafts good for large extremity defects
  • Offer rapid healing of chronic wound
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15
Q

what are the 9 ypes of open wounds?

A
  • Abrasion
  • Avulsion
  • Burn
  • Degloving
  • Incision
  • Laceration
  • Pressure sore
  • Puncture
  • Shearing
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16
Q

what is an abrasion wound?

A
  • Superficial wound caused when skin moves parallel to a rough surface at speed
  • Does not extend deep to dermis
  • Common with RTA
  • Pads abraded when excess exercise on rough surface
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17
Q

what is an avulsion wound?

A
  • Tissue is torn from attachments
  • Ligaments / Muscles / Skin
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18
Q

what is a burn wound?

A
  • Thermal (dry / wet)
  • Chemical / radiation / electrical
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19
Q

what is a degloving wound?

A
  • A type of severe avulsion that affects legs, tails (extremities)
  • Extensive skin loss like a ‘glove’ being removed
  • Mechanical
  • Skin pulled from subdermal attachments
  • Physiological
  • Skin necroses and sloughs due to damage to blood supply
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20
Q

what is an incisional wound?

A
  • Surgical or traumatic
  • Glass / wire / other sharp objects
  • Typically skin deep only & clean cut
  • Worth exploring to check for damage to deeper tissues
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21
Q

what is a laceration wound?

A
  • Tearing injury
  • Damages skin and deeper tissues
  • Irregular edges
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22
Q

what is a pressure sore?

A
  • Found on elbows/hocks of large breed dogs
  • Can be graded for severity depending on depth of damage & if very severe > open
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23
Q

what is a puncture wound?

A
  • An object creates a relatively small hole
  • Bites
  • Gun shots / stabbings
  • Penetrating foreign bodies like grass seeds / stick injuries
  • Snakes, insects, spider bites
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24
Q

what are shearing wounds?

A
  • Similar aetiology to degloving
  • Usually involve loss of deeper tissues
  • When limbs affected may expose joints and/or bone
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25
Q

what are the 4 types of closed wounds?

A
  • Contusion
  • Crush injury
  • Haematoma
  • Hygroma
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26
Q

what is a contusion?

A
  • An area of injury where capillaries have been damaged = a bruise
27
Q

what is a crush injury?

A
  • Caused by prolonged period of compression
  • Direct tissue injury
  • Secondary injury from damage to blood supply
28
Q

what is a haematoma?

A
  • Blood vessel damage underneath the skin
  • Accumulation of blood in a pocket
29
Q

what is a hygroma?

A

a kind of pressure sore

30
Q

what types of bandaging wounds are there?

A
  • Open/closed
  • Over-tight
  • Inadequate padding
  • Excess exercise
  • Wet/dirty
31
Q

what contamination can be in a wound?

A

micro-organisation, debris

32
Q

what might prevent a wound from healing?

A
  • immuno-suppressive conditions
    -poor ntrition
  • drug therapy
  • stress
33
Q

what surgical considerations are there for wound types?

A

➢ What (wound) have we got here?
➢ What (aetiology) have we got here?
➢ What (patient) have we got here?
➢ When are we likely to take this to surgery?
➢ Where is the wound?

34
Q

what are the stages of skin healing?

A

inflammaition, proliferation, maturation

35
Q

how woul you assess the patient?

A
  • Pre-existing co-morbidities
  • Current status
  • Injuries
  • Primary vs delayed wound management
36
Q

what are client factors that you should consider?

A
  • cost
  • owner compliacne with revisits, bandage management and medications
  • practicalities
37
Q

what does the acronym TIME stand for?

A

Tissue, Infection/inflammation, Moisture, Epithelisation

38
Q

what is the aim for TIME?

A
  • Remove non-viable tissue
  • Treat infection / factors pre-disposing to infection
  • Ensure optimal moisture balance
  • Identify delayed healing
39
Q

what is viable tissue?

A

epithelial and granulation

40
Q

what is non-viable tissue?

A

sloughing and necrosis

41
Q

what are you considering with pre-existing infection wounds?

A
  • the age of the wound
  • is there discharge?
  • is there a smell
42
Q

what are you considering with the risk of infection of a wound?

A
  • site of the wound
  • wound aetiologu
  • degree of contamination
  • wound lavage
43
Q

what are you considering with an inflammed wound?

A

unhealthy = infection
- healthy = granulation and healing

44
Q

what can happen if a wound is too wet?

A

skin ca become macerated of excoriated

45
Q

what can happen if a wound is too dry?

A

the wound can become desiccated and eschar may be present

46
Q

what should you do if a wound is too wet?

A

try to absorb some of the moisutre

47
Q

what should you do if a wound is too dry?

A

add moisture to the wound

48
Q

how would you assess wounds?

A
  • Wound edges= Pink, smooth = healing
    -Darker red, uneven = not healing
  • Measurements (Width, Length, Depth
  • Photos
  • Drawings
  • Tissue surrounding wound (Cellulitis, Oedema, Skin
49
Q

what are you looking for with assessing of a wound?

A

progression and reasons for non-progression

50
Q

how would you promote epithelisation?

A

use TIME

51
Q

how would you protect new epithlial tissue?

A

bandaging

52
Q

why would you lavage a wound?

A
  • Rehydrate necrotic tissue
  • Remove foreign material
  • Reduce bacterial contamination
  • Remove toxins & cytokines
53
Q

what would you use to lavage a wound?

A
  • Isotonic fluid; Hartmann’s may be marginally better than saline
  • Tap water
  • Additives?
54
Q

when would you lavage a wound?

A

any traumatic wound

55
Q

where would you lavage a wound?

A
  • Aseptically
  • Clip and sterile prep – aqueous gels for trapping fur
  • Use a lot of liquid! Dilution is the solution
56
Q

how would you lavage a wound?

A
  • Should not require sedation
  • Fluid bag with giving set
  • 20ml syringe, 18g needle, 3-way tap
  • Care not to apply too high pressure as can push the things we are trying to remove into deeper tissues > areolar tissue will show this by having a bubble-wrap
    appearance
57
Q

what is surgical debridement?

A
  • Sharp dissection to remove all contaminated, necrotic tissue
  • Avoid damage to normal tissue
58
Q

what non-surgical debridement can be done?

A
  • Physical = Using adherent dressings that remove tissue when the dressing is
    removed
  • Chemical = using chemical substances to remove the dead tissue
59
Q

why would you bandage an open wound?

A

Protect from
* Self-trauma
* Contamination / infection from environment
* Desiccation

60
Q

what can bandaging an open wound provide?

A
  • Pain relief
  • Immobilisation of soft and any concurrent ortho injuries
  • Pressure to reduce swelling / haemorrhage
  • Deliver topical medications
61
Q

what can you use for a chemical debridement of an open wound?

A
  • Hydrogels
  • Enzymatic / other agents
62
Q

what can you use for physical debridement of an open wound?

A
  • Wet to dry
  • Dry to dry
  • Larvae
63
Q

what is the nurses role in wound management?

A
  • Continuity
  • Advocacy
  • Nurse clinics
  • Clinic audits

ACVN - SURGICAL NURSING (17 decks)

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