Surgical wounds Flashcards
types of surgical wound healing
Primary intention
Secondary intention
Tertiary or delayed primary closure
primary intention
Edges approximated during surgery
Suture, staples, bio surgical glue
Secondary intention
Left open after surgery
healing with scar tissue
tertiary or delayed primary closure
Initially wound left open then after a short time, edges are approximated
primary intention considerations
most common
But there is a risk of infection
Amount of tissue removed can cause a deep cavity
Closure would result in too much tension and can lead to edema
Positive signs of healing days 1 to 4
edges approximated
Normal inflammation
Minimum to moderate drainage
Bloody progressing to serosanguineous
primary dressing- non adherent gauze
Negative signs of healing days one to four
no signs of inflammation
Tension along the incision line
Positive signs of healing days 5 to 9
no inflammation
No drainage
New epithelium along entire incision line
Healing Ridge present
Firmness along incision line from collagen deposition
Feels like a pencil under the incision line
Negative signs of healing days 5 to 9
drainage
Little to no new pink epithelium
Absent or partial healing ridge
Signs and symptoms of infection
Dehiscence
signs of positive healing days 10 to 14
Sutures and staples remove
Pink or darker incision site
Tiny openings post removal
Negative signs of healing days 10 to 14
signs of inflammation or infection
Drainage
dehiscence- opening of the incision
Absent or partial healing ridge
positive signs of healing days 15 up to 1-2years
Pale scar progressing to white or silver
Will be darker and darkly pigmented skin
Scar will always be weaker only up to 80% of full strength
Altered healing days 15 up to 1-2 years
keloid or hypertrophic scarring
suture removal time frames
Generally 10 to 14 days
For the face 3 to 5 days
dressing surgical wounds
Dry or non-adherent gauze
bordered foam
May see Betadine dabs along incision line
when is the moist dressing appropriate for a surgical wound?
Viable tissue is exposed
impregnated gauze cut to fit over opening
And dry gauze over the rest
Risk factors for dehiscence
tension edema
Smoking
Infection osteomyelitis
Trauma
Hypertension
Stress
Malnutrition
Decreased healing potential due to diabetes, HIV or PAD
Surgical site infection
most common nosocomial infection
Majority are related to incision
when should the PT contact the provider?
Early increased sanguineous drainage
Change to purulent drainage
Drainage after 5 to 6 days
absence of healing ridge after 10 days
infection - local day 4 or systemic anytime
dehiscence
Increased pain
Consider contributions of increased mobility
