Surgical Wounds

Question 1

What is a wound?

Answer 1

An injury to living tissue caused by a cut, blow, or other impact, typically one in which the skin is cut or broken

Question 2

4 phases of wound healing

Answer 2

Hemostasis phase
Inflammatory phase
Proliferation phase
Maturation phase

Question 3

Hemostasis phase

Answer 3

• Happens in minutes/hours after injury
• Blood vessels constrict
• Platelet aggregation - clot formation
• Leucocytes attracted to site of injury
• Vasodilation of surrounding vessels - erythema
• Plasma leakage - inflammation

Question 4

Inflammatory phase

Answer 4

• Erythema, heat, swelling occur
• Neutrophils migrate to area and start phagocytosis of bacteria
• Exudate levels increase
• About 0-3 days
• This stage is where healing may be suppressed - steroids/cytotoxic drugs

Question 5

Proliferation phase

Answer 5

• Wound begins to fill eith connective tissue
• macrophages stimulate formation of new capillary growth in wound bed
  development of new connective tissue
• Identified by granular and slightly uneven appearance
• About 3-24 days

Question 6

Maturation ohase

Answer 6

• wound closed
• scar appears, blood supply decreases
• scar 80% as strong
• around 24 days to 2 years

Question 7

Healing by primary intention

Answer 7

• most surgical wounds
• wound edges opposed by either sutures
• usually clean wounds
• normal healings, minimal scarring

Question 8

Healing by secondary intention

Answer 8

• wounds with more extensive loss of cells
• can be used for contaminated wounds
• granulation tissue grows in from margins to complete the repair
• more inflammation, more granulation tissue, more wound contraction

Question 9

healing by tertiary intention

Answer 9

• delayed primary closure
• wound initially left open
• edges later opposed
• wound closure delayed to allow for reduction in exudate and swelling

Question 10

Local factors affecting wound healing

Answer 10

Oxygenation
Infection
Foreign body
Venous sufficiency

Question 11

Systemic factors affecting wound healing

Answer 11

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

Question 12

Class I/ clean wound

Answer 12

• uninfected surgical wound in which no inflammation encountered
• primarily closed
• prophylactic ABx not routinely given

Question 13

Class II/ clean- contaminated wound

Answer 13

• surgical wound in which resp/gi/urinary tract entered, no major break in technique
• prophylactic ABX regularly given

Question 14

Class III - contaminated wound

Answer 14

• includes open trauma wounds
• op procedures involving spillage from GI, GU or billiart tradtd

Question 15

Class IV - Dirty or infected

Answer 15

• heavily contaminated before operation
• eg: perforated viscera, abcesses
• giving therapuetic ABx is

Question 16

Post op

Answer 16

For non-absorbable sutures, need to come back for the sutures to be removed.
- Sutures on the face- 3-5 days
- Sutures on the head – 5 to 7 days
- Sutures over joints (like knees or elbows) –after 10 to 14 days
- Back sutures- 14 days
- Abdominal sutures- 7 days
- Sutures on other parts of your body –after 7 to 10 days
*if a sutured wound is infected with pus, drain the pus by removing several sutures