Surgical Wounds Flashcards
What is primary intention for surgical wound healing?
edges of wound are approximated during surgery with sutures, staples or dermal glues
What is secondary intention for surgical wound healing?
wound is left open after surgery and heals with scar tissue
What is tertiary or delayed primary closure for surgical wound healing?
wound initially left open but then approximated after a short time
In the 1-4 day mark after a surgery what are the good and bad signs of healing?
Good:
-edges approximated
-normal inflammation
min to mod drainage
Bad:
- no signs of inflammation
- tension along the incision line
primary dressing should be dry or non adherent gauze
In the 5-9 day mark after a surgery what are the good and bad signs of healing?
good:
- no inflammation
- no drainage
- new epithelium alone entire incision line
- healing ridge is present (firmness along incision line from collagen deposits)
Bad:
- drainage
- little or no new pink epithelium
- no healing ridge
- signs of infection
- dehiscence
In the 10-14 day mark after a surgery what are the good and bad signs of healing?
Good:
- sutures are removed
- pink incision site
- tiny opening post removal
Bad:
- signs of inflammation or infection
- drainage
- dehiscence
- no healing ridge
In the 15+ day mark after a surgery what are the good and bad signs of healing?
Good:
-pale scar progressing to white (remember scar is only 80% as strong as skin)
Bad:
Keloid or hypertrophic scarring
About how long should it be until sutures are removed from a facial surgery?
Scalp surgery?
Chest, extremities and abdomen?
Back and foot?
Ear?
3-5 days
7 days
7-10 days
12-14 days
10-14 days
What is the most common post surgery wound dressing?
When is moist wound dressing appropriate for surgical wounds? WHat type is appropriate
dry or non adherent gauze or bordered foam
impregnated gauze covered by dry gauze is indicated if viable tissue is exposed
Why might a surgeon not close a wound with primary intention?
- risk of infection
- too much tissue was removed
- closure would result in too much tension
What can cause dehiscence?
- tension and edema
- smoking
- infection/osteomyelitis
- trauma
- HTN
- stress
- malnutrition
- decreased healing potential
What are the risk factors for dehiscence?
- advanced age
- anemia
- chronic pulmonary disease
- infection
- increased intra-abdominal pressure
Where do a majority of surgical site infections come from?
How should hair be removed before surgery?
the incision
with clippers not with shaving
What is the basic care for surgical incisions?
- keep it dry
- protect it from tension
- clean and debride as needed
- monitor
When should a PT contact an MD about a patients wound?
- early increased blood drainage
- change to purulent drainage
- drainage after 5-6 days
- no healing ridge by day 9
- infections signs
- dehiscence
- increased pain
