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Surgery Lectures > Surgical Wounds > Flashcards

Surgical Wounds Flashcards

1
Q

What is the process of wound healing?

A

There are 4 phases

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2
Q

What are the four phases of wound healing?

A
    • Hemostasis phase
    • Inflammatory phase
    • Proliferation phase
    • Maturation phase
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3
Q

What is the Hemostasis phase?

A
  • It happens in minutes-hours after an injury.
  • Blood vessels constrict seconds after the injury
  • Platelet aggregation clot forms
  • Leucocytes attracted to the injured area
  • Vasodilatation of the vessels surrounding the wound erythema
  • Plasma leakage- inflammation
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4
Q

What is the inflammatory phase?

A
  • Erythema, heat & swelling occur
  • Neutrophils migrate to the area & start phagocytosis of bacteria
  • Macrophages engulf bacteria & dead WBCs
  • Slough (necrotic tissues) may be present with exudate (bodily fluids)
  • Exudate levels increase
  • Protease enzymes breakdown damaged tissues
  • About 0-3 days duration
  • At this stage where healing may be suppressed (patients on steroids or cytotoxic drugs, arterial/venous disease, etc)- chronic wound
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5
Q

What is Proliferation phase?

A
  • Wound begins to fill with connective tissue (granulation tissue- reddish)
  • Macrophages stimulate the formation of new capillary growth in the wound bed (angiogenesis- growth of new blood vessels )
  • Development of new connective tissue (collagen)
  • Identified by its granular and slightly uneven appearance.
  • Contraction also occurs causing a reduction in wound size
  • About 3-24 days
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6
Q

What is Maturation Phase?

A
  • Wound is now closed because of connective tissue epithelialization.
  • Cellular activity slows down.
  • A scar appears.
  • As the scar matures, the blood supply decreases resulting in a flatter scar giving a better cosmetic result.
  • At best the scar will only be 80% as strong as uninjured tissue.
  • About 24 days to 2 years
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7
Q

Describe in step by step the 4 phases of would healing?

A

Day (1-3) Hemostasis -stop bleeding

Day (3-20) Inflammation -new frameworkfor blood vessel growth

Week (1-6) Proliferation -pulls the wound closed

Week (6-2 yrs) Maturation- Final proper tissue

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8
Q

What are the classification of wound healing?

A
  • Primary intention
  • Secondary intention
  • Tertiary intention
    *
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9
Q

What is healing by primary intention?

A
  • The way most surgical wounds are closed.
  • Wound edges opposed by either sutures, skin closure strips or wound adhesive.
  • Used to close clean or clean contaminated wounds with limited tension.
  • Normal healing occurs.
  • Minimal scarring occurs
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10
Q

What is healing by secondary intention?

A

Used in wounds that have more extensive loss of cells, or surface wounds that create large defects wound is left open
Can be used for contaminated or dirty wounds.
Granulation tissue grows in from the margins to complete the repair.
An ugly scar is produced.
Difference from primary intention:
Inflammatory reaction is more intense.
Much larger amounts of granulation tissue are formed.
Wound contraction is much more.

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11
Q

what do you do if wound is infected ?

A
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12
Q

What is healing by tertiary intention?

A
  • The wound is left open!
  • later, the edges opposed when healing
  • Wound closure is delayed to allow for reduction in exduate and swelling(48-72)hrs
  • Once exudate and swelling reduced the wound edges are brought together
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13
Q

What are the factors that would affect the wound to heal?

A

Two factors
Local and systemic

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14
Q

What are the local factors?

A

Oxygenation
Infection
Foreign body
Venous sufficiency

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15
Q

What are the systemic factors?

A

Age and gender
Sex hormones
Stress
Ischemia
Diseases: DM, uraemia, healing disorders
Obesity
Meds: steroids & chemo drugs
Alcoholism and smoking
Immunocompromised conditions: cancer, radiation therapy, AIDS
Nutrition

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16
Q

Explain Local factors?

A

**Oxygenation **
O2 is essential for collagen formation
Collagen fibril assembly proceeds poorly when partial pressure of oxygen (PO2) becomes less than 40 mm Hg

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17
Q

Infection in Local factors include

A

Pathogenic micro-organisms produce toxins and destructive enzymes, release of free radicals, degradation of growth factors

causes down-regulation of immune response and interferes with collagen formation

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18
Q

What is the presence of foreign body in local factors?

A
  • Host’s immune system views as “non self”, including bacteria, dirt, suture material
  • Reaction is characterized by exudate accumulation, at the site of injury, infiltration of inflammatory cells- chronic inflammation
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19
Q

What is Venous insuffieciency in Local Factors?

A

Impairs wound healing by decreasing diffusion of O2 and nutrients to surrounding tissue

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20
Q

What are the systemic factors?

A

Age
Stress ( biopsycosocial )

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21
Q

What does the stress bring in systemic factors?

A
  • Deregulation of the immune system
  • Up-regulates glucocorticoids (GC) & reduces the levels of the proinflammatory cytokines at the wound site.
  • Psychological stress impairs normal cell mediated immunity at the wound site delay in healing
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22
Q

What is the effect of systemic factors in obesity ?

A

Inherent decreased vascularity of adipose tissue poor circulation & limited blood supply to the wound.
Obesity also induces a chronic low-grade inflammatory process.

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23
Q

What is the effect of systemic factors in Diabetes?

A

Impaired leukocyte migration due to wall thickening.
Hyperglycaemia inhibits normal collagen degradation.

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24
Q

What is the effect of systemic factors in Medications?

A

Steroids-
Suppresses fibroblast proliferation & collagen synthesis.
Incomplete granulation tissue formation, reduced wound contraction and increase risk of wound infection.

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25
Q

What is the effect of systemic factors in Chemotherapeutic drugs?

A

Inhibit cellular metabolism, rapid cell division, and angiogenesis.
Weakens immune system higher risk of wound infection.

26
Q

What is the effect of systemic factors in Alcohol and smoking?

A

Alcohol
* Diminishes host resistance increased susceptibility to infection in the wound
* Impairs the process of angiogenesis

Smoking

  • Nicotine induces tissue ischemia via vasoconstrictive effects
  • Nicotine & carbon monoxide in cigarette smoke causes tissue hypoxia
27
Q

What are the effect on Nutrition in systemic factors?

A

**Fats & carbohydrates **
primary source of energy for angiogenesis and deposition of the new tissue

**Proteins **
one of the most important nutrient factors affecting wound healing
deficiency can impair capillary formation, fibroblast proliferation, collagen synthesis, and wound remodelling.

Vitamins & micronutrients
Vitamin C & A deficiency decreased collagen & fibroblast proliferation
Vitamin E maintains and stabilizes cellular membrane integrity by providing protection against destruction by oxidation

28
Q

What are the different types of Wounds?

A
  1. Mode of injury
  2. Wound depth
  3. Duration of healing
  4. Potential risk of infection
  5. Specific types of wounds
29
Q

What are the 2 types of wound depth?

A

Partial-thickness
Full-thickness

30
Q

What is Partial thickness ?

A

Wounds that involve only the epidermis or the epidermis into the dermis

31
Q

What is Full-thickness?

A
  • Wounds penetrate completely through the skin into underlying tissues and may expose adipose tissue, muscle, tendon, or bone.
  • These heal by granulation and contraction, requiring more body resources and time
32
Q

What are the types of healing?

A

Acute
Chronic

33
Q

What is Acute wounds ?

A

that repair by themselves and proceed normally by following a timely and orderly healing pathway, with end-result is restoration of both structure and function
Ex: surgical incisions

34
Q

What is Chronic wounds?

A

fail to progress through the normal stages of healing cannot be repaired in an orderly and timely manner.
Ex: pressure ulcers, venous stasis ulcers, DM foot

35
Q

What is the potential risk of infection?

A

Class I/Clean Wounds
An uninfected surgical wound in which no inflammation is encountered and the respiratory, alimentary or uninfected urinary tracts are not entered.
These are primarily closed and, if necessary, drained with closed drainage.
Prophylactic antibiotics not routinely given.

36
Q

What is Prophylatic ?
What is Therapeutic?

A
37
Q
A
38
Q

What is the potential risk of infection?

A

Class II/Clean-Contaminated Wounds
* A surgical wound in which the respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions and without unusual contamination, no major break in technique occurs.
* Examples: chest procedures, ear surgeries, bowel resections .
* Prophylactic antibiotics are routinely given.

39
Q

What is the Class 3/contaminated wounds Potential risk of infection?

A
  • Includes open traumatic wounds (open fractures, penetrating wounds)
  • Operative procedures involving spillage from the GI, GU or biliary tracts (major break in sterile technique)
  • Prophylactic antibiotics are always given, and sometimes continued as therapeutic antibiotics.
40
Q

What is the Class 4/dirty or infected wounds potential risk of infection?

A

Heavily contaminated/infected wound before an operation
Includes: perforated viscera, abscesses, wounds with undetected foreign body/necrotic tissue.
Can be closed by secondary/tertiary intention.
Giving therapeutic antibiotics is part of the management.

41
Q

what are the various wounds in Surgery?

A

Abscesses
Lacerations
Stab Wounds
Pressure Ulcers
Diabetic Foot
Necrotizing Fasciitis
PAD Ulcers and Venous Stasis Ulcers

42
Q

what are the different types of wound closure ?

A

Stitches
Staples
Medical Tape
Glue

43
Q

What is a suture?

A
  • Standard of care for primary wound closure and are Various types of sutures available.
  • Choice of suture and technique depends on the type of wound, depth, degree of tension, and desired cosmetic results.
  • Sutures are widely available.
    Can be used in different parts of the body (face, hands, oral cavity).
  • Suture removal requires forceps & surgical scissors (except for absorbable sutures).
44
Q

What are staples?

A
  • Commonly used alternative to suturing.
  • Made of steel and are rectangular in shape.
  • Provides faster speed of closure and reduced rate of infection.
  • Used for linear lacerations in non-cosmetic areas.
  • Has the greatest tensile strength used in high-tension wounds (scalp).
  • Should not be used on hands/face due to scarring.
  • Not often used in paediatric surgeries.
    Removal requires a special tool.
45
Q

Tissue Adhesives

A
  • Convenient alternative to sutures.
  • Can be used to close small, clean, simple lacerations with no wound tension.
  • Tends to be faster and less painful than suturing & lack of a need for suture removal.
  • Risk of dehiscence is possible (check after 2 days).
  • Not used in wounds with tension, complex laceration pattern, dirty wounds, and wound sizes deeper or longer than 10 cm.
  • Lacerations in areas with excessive hair or in skin creases are relative contraindications
46
Q

What is Tape?

A
  • Strips can be applied easily, pain-free, and are inexpensive.
  • Space can be left between strips to allow some drainage if haemostasis is imperfect.
  • Useful for small wounds in which suturing might not be necessary.
  • Suitable in children because their application can be close to painless
47
Q

What are the types of Wound dressings available?

A

Gauzes
Transparent films
Foams
Hydrogels
Hydrocolloids

48
Q

Describe Gauzes?

A
  • Provides mechanical debridement when removed.
  • Advantages: Cost-effective and widely available.
    Disadvantages:
  • not moisture-retentive
  • dressing change can lead to removing new granulation tissue
  • dressing is susceptible to bacterial contamination
  • Clinical application: early stages of deeper wounds that require packing.
  • Frequency of dressing changes: Change dressing multiple times a day if used for packing
49
Q

What are Films?

A
  • Films are thin and transparent dressings.
  • Advantages:
    retain moisture & provide the ability to monitor wounds visually.
    semi-permeable, thus allowing for gas exchange while not allowing for external bacteria to enter the wound
    self-adhesive.
    Disadvantages:
  • non-absorbent and impermeable to fluid; thus can cause maceration.
  • Clinical applications: used shallow wounds, skin graft donor sites, IV sites, and secondary dressings.
  • Contraindications: wounds with heavy exudates or infected wounds.
  • Frequency of dressing changes: every few days a week to routine dressing changes every 7 days
50
Q

WHat is Foam?

A

Bilayer dressing: inner layer is polyurethane or silicone, while the outer layer is a hydrophobic, permeable layer.
Advantages:
Foams absorb exudate.
Their thickness allows for extra protection from external trauma.
Disadvantages:
inability to visualize wounds and drying out a wound.
Clinical application: moderate to heavy exudative and chronic wounds and pressure injuries.
Frequency of dressing changes: Change daily or a few times a week

51
Q

What is Hydrogels?

A

Hydrogels are hydrophilic starch polymers (predominately composed of water).

52
Q

What are the advantages of Hydrogels?

A

absorbs water and provides a cooling effect, which can reduce pain.
provide a moist environment which encourages autolytic debridement; prevents dessication

53
Q

What are the disadvantages of Hydrogels?

A

have a low absorptive capacity and require a secondary dressing (not for heavy exudative wounds)

54
Q

What is the clinical application that hydrogels is used for?

A

Venous or arterial ulcers and first aid for burns

55
Q

What is the frequency of dressing(hydrogel) changes?

A

Every 1 to 3 days

56
Q

What is Hydrocolloids?

A

Hydrophilic polymers with cellulose, gelatin, or pectin

57
Q

What are the advantages and disadvantages of Hydrocolloids?

A
  • The advantages are that it progressively absorb water, becoming more permeable and forming a gel.
  • The lower wound pH, inhibiting bacterial growth.
  • It can be placed across joints or fill wound cavities
58
Q

What is the clinical application of Hydrocolloids used for?

A

pressure wounds and minimal to moderate exudative wounds.

59
Q

What is the frquency of dressing changes for Hydrocholloids?

A

Every 2 to 4 days

60
Q

What is Alginates ?

A

This seaweed polysaccharide dressing has calcium ions exchanged for sodium ions to transform into a gel.

Surgery Lectures (12 decks)

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