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ED/Surgery > Sutures, Wound Care > Flashcards

Sutures, Wound Care Flashcards

1
Q

Direction that wounds heal and direction that epithelial tissue heals

A

wound bottom to top

skin side to side

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2
Q

Primary vs secondary vs tertiary intention in wound closure

A

primary: clean incision, early suture, minor hairline scar forms
secondary: gaping wound with blood clot, no suture so granulation tissue fills in wound, larger scar
tertiary: allow wound to fill with granulation, late suturing, wide scar

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3
Q

How to treat wound infection that has been sutured?

A

open and drain

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4
Q

6 steps on how to approach fresh, uncomplicated wound

A
  1. Consent to treat / procedural consent
  2. Tetanus prophylaxis
  3. Anesthesia
  4. Hemostasis
  5. Cleaning and debridement
  6. Wound closure
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5
Q

PARQA format of informed consent

A 
Procedure
Alternatives
Risks
Questions
Answers
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6
Q

Methods to achieve hemostasis

A

Direct Pressure!
Electrocautery
Chemical cautery (silver nitrate)
Suture ligation

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7
Q

Cleaning and debridement of wound

A

Copious saline, LR, or water
Scrub wound
J&J Baby wash
Remove foreign bodies

*anti-microbial soaps not beneficial

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8
Q

Where should staples NOT be used?

A

hands, feet, neck, face

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9
Q

Edges of skin should be in what position for best epithelialization?

A

everted

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10
Q

Which basic appositional suture pattern has least chance of dehiscence?

A

simple interrupted

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11
Q

Best suture pattern for wounds under tension

A

vertical mattress

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12
Q

Where do you avoid suturing in V-shaped wound?

A

tip of flap because it is likely to become necrotic

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13
Q

When should patient f/u for sutures to be removed?

A 
depends on location:
Face: 3 to 5 days
Scalp: 7 to 10 days
Neck: 5 to 7 days
Extremities: 10 to 14 days / 14 to 28 days under tension (joints)
Back: 10 to 14 days
Abdomen: 7 to 10 days
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14
Q

What is most commonly used needle point for suturing?

A

reverse cutting

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15
Q

Most common absorbable sutures

A

Vicryl; strength for 2-3 wks, reabsorbs in 50-75 days

chromic gut; strength for 7 days, reabsorbs in few days

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16
Q

Types of non-absorbable sutures

A

silk, polypropylene, stainless steel, nylon, polyester

17
Q

What should you always do before anesthetizing a wound?

A

check distal sensation and motor function

18
Q

Local anesthetics for wounds - short and longer acting?

A

Lidocaine (short-acting)

Bupivacaine (3-6 hrs)

19
Q

Where do you inject local anesthetics for wound?

A

clean (surgical procedure) - you can inject inside of wound

dirty - edge of wound

20
Q

When do you use epinephrine for local anesthetic and when should you avoid it?

A
  • Can’t achieve hemostasis

- Need anesthesia more long-lasting than Lidocaine (+30 min)

21
Q

6 phases of wound healing

A
  1. Hemostasis
  2. Inflammation
  3. Epithelialization
  4. Collagen synthesis
  5. Scar maturation
  6. Scar remodeling
22
Q

______ begin the task of removing cellular debris, bacteria, and foreign bodies during inflammatory healing phase.

A

PMN leukocytes

23
Q

What occurs during hemostasis phase of healing?

A

Vasoconstriction
Platelets clump
Thrombin and fibrin strands
Clotting cascade initiated to form clot

24
Q

During which phase of healing does neo-vascularization occur? Why is neo-vascularization important?

A

Epithelialization

replaces injured BV network and brings oxygen and nutrients to healing wound

25
Q

Why do wound edges normally become more erythematous and raised?

A

area abundant with new collagen and capillaries bed

26
Q

What is the purpose of fibroblast proliferation?

A

secrete tons of collagen around wound

27
Q

What is scarring composed of?

A

collagen

28
Q

Three D’s of wound cleaning

A

Remove debris
Debride the wound
Excise devitalized tissue

29
Q

What should wound ideally be washed with?

A

normal saline

30
Q

Best hemorrhage control

A

direct pressure and elevation

31
Q

Which intention healing should gun shot wound be treated with?

A

tertiary intention (delay primary suture)

32
Q

Timeframe of primary intention

A

usually suture if injury within 8 hrs

face, scalp, and neck wounds within 24 hrs

33
Q

Reasons for secondary intention

A 
Old wound
Any infected, open wound
Contamination
Open wound with large tissue defect
Abrasions
Penetrating wounds (bites, stab)
34
Q

Of non-absorbable sutures, _______ which are least reactive and result in least amount of scarring.

A

monofilament nylon

35
Q

Prophylactic antibiotics for wounds

A

IM or IV 1st generation cephalosporin or penicillinase-resistant penicillin

if allergic Erythromycin or Cipro

36
Q

When are antibiotics indicated for wound?

A

Lacerations with bone, cartilage, tendon, or joint injuries
Animal or human bites
Patients with artificial valves or other prosthetic devices (joint replacement)

ED/Surgery (16 decks)

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