Surgical Wounds Flashcards
Describe a clean/ contaminated wound
Surgical wounds of the genitourinary, respiratory or alimentary/oropharengeal cavity. Contaminated by resident flora. No reaction by host
Describe a clean wound
Wounds made under aseptic surgical aseptic technique. No clinical signs of infection. Don’t enter genito urinary, respiratory or alimentary tracts/ oropharengeal cavity
Describe a contaminated wound
Contaminated by bacteria. Honest reaction. No pus.
Describe an infected wound
Clinical signs of infection (pain, heat,swelling,redness,^exudate). Increased leukocyte and macrophages. Chronic wound infection signs.
List the signs of a chronic wound infection
New or increased pain. Delayed healing. Friable, bright red hyper granulation. Pocketing/irregular deposition of granulation tissue, bridging tissue. Malodour and ^exudate.
List the surgical methods for primary wound healing
Sutures, staples, surgical tape, tissue glue (histacryl)
List the surgical wound healing methods for delayed primary intention
Suture after 3-10 days
What are the two types of natural sutures?
Absorbable and non-absorbable
Describe the two types of Natural absorbable sutures
Natural - purified collagen.
Catgut (plain or chromic)
- plain: rapidly absorbed, tensile strength, lasts 7-10 days.
-chromic: treated with chromium salt solution to resist enzymes, last 10-14 days.
Describe Non-absorbable sutures
Silk
Linen
Stainless steel
What are the four types of synthetic sutures?
Absorbable e.g. polyglycolic acid, polyglactin
Non absorbable e.g. Polyamide,polyester,polypropylene
Vicryl e.g. Tensile strength 65@14days ,40%@21 days10%35days
Poly dioxane e.g. Tensile strength 70%@14days,50%@28days. Absorption complete by 180 days.
Name the four types of suture techniques
Simple square, interrupted sutures, mattress sutures, continuous sub cuticular sutures and tension sutures
Describe simple square interrupted sutures
Inserted 1cm apart and 1cm across
Describe mattress sutures
Less pressure/tension on wound opening.
Vertical: in,under wound, out other side, then in,back across, out, knotted.
Horizontal: same as above, only sit parallel with incision line
Describe continuous subcuticular suture
One piece of suture. Start by going into SC inside wound, come up , leave a stitch, go into skin, across other side, repeat
Describe tension sutures
Inserted into deep tissue, provide additional support, nylon sutures covered with polyurethane cove to prevent cutting into skin.
Describe wound closure strips
Adhesive strips. Eg. Steri strips or leukocyte-strips
What are the principles for wound healing by primary intention?
Protect the wound from physical or pathogenic assault Absorb exudate Maintain wound temperature Maintain body temperature Oxygenation Avoid stress-pain relief Observe suture line for complications
What can you use to dress a suture line?
Keep dressing on for 24-48 hours (unless there is a drain ) Dry low-adherent dressings Island dressings Semi permeable film Hydro colloid Foam
What are the indications for a drainage tube
Abscesses cavity-prevent premature closure
Insecure intra abdo wound- compromised healing, malnourished
Anticipated exudate
Risk of peritonitis -bowel, gastric, biliary
Extensive dissection- large collections
Traumatic injury- to drain contaminants
List the 3 types of drains
Capillary wicking:Penrose, corrugated,ported
Attached negative pressure suction devices: redivac, Jackson Pratt, sump,axiom
Percutaneous: biliary, nephrostomy
What are the indications for percutaneous tubes?
Gastrostomy - feeding or decompression Jejunostomy- feeding Nephrostomy - draining urine Supra public catheter -draining urine Biliary-draining bile
Describe peri tubular skin care
Keep skin clean and dry
Peri tubular leakage -indicates width of tube is too small for fistula track
Hypergranulation around tubes indicates friction - secure tube
What is a Biliary T-Tube?
Inserted into the biliary track to drain bile following a cholecystectomy.