Sutures, Wound Care Flashcards
Direction that wounds heal and direction that epithelial tissue heals
wound bottom to top
skin side to side
Primary vs secondary vs tertiary intention in wound closure
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
How to treat wound infection that has been sutured?
open and drain
6 steps on how to approach fresh, uncomplicated wound
- Consent to treat / procedural consent
- Tetanus prophylaxis
- Anesthesia
- Hemostasis
- Cleaning and debridement
- Wound closure
PARQA format of informed consent
Procedure Alternatives Risks Questions Answers
Methods to achieve hemostasis
Direct Pressure!
Electrocautery
Chemical cautery (silver nitrate)
Suture ligation
Cleaning and debridement of wound
Copious saline, LR, or water
Scrub wound
J&J Baby wash
Remove foreign bodies
*anti-microbial soaps not beneficial
Where should staples NOT be used?
hands, feet, neck, face
Edges of skin should be in what position for best epithelialization?
everted
Which basic appositional suture pattern has least chance of dehiscence?
simple interrupted
Best suture pattern for wounds under tension
vertical mattress
Where do you avoid suturing in V-shaped wound?
tip of flap because it is likely to become necrotic
When should patient f/u for sutures to be removed?
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
What is most commonly used needle point for suturing?
reverse cutting
Most common absorbable sutures
Vicryl; strength for 2-3 wks, reabsorbs in 50-75 days
chromic gut; strength for 7 days, reabsorbs in few days
Types of non-absorbable sutures
silk, polypropylene, stainless steel, nylon, polyester
What should you always do before anesthetizing a wound?
check distal sensation and motor function
Local anesthetics for wounds - short and longer acting?
Lidocaine (short-acting)
Bupivacaine (3-6 hrs)
Where do you inject local anesthetics for wound?
clean (surgical procedure) - you can inject inside of wound
dirty - edge of wound
When do you use epinephrine for local anesthetic and when should you avoid it?
- Can’t achieve hemostasis
- Need anesthesia more long-lasting than Lidocaine (+30 min)
6 phases of wound healing
- Hemostasis
- Inflammation
- Epithelialization
- Collagen synthesis
- Scar maturation
- Scar remodeling
______ begin the task of removing cellular debris, bacteria, and foreign bodies during inflammatory healing phase.
PMN leukocytes
What occurs during hemostasis phase of healing?
Vasoconstriction
Platelets clump
Thrombin and fibrin strands
Clotting cascade initiated to form clot
During which phase of healing does neo-vascularization occur? Why is neo-vascularization important?
Epithelialization
replaces injured BV network and brings oxygen and nutrients to healing wound
Why do wound edges normally become more erythematous and raised?
area abundant with new collagen and capillaries bed
What is the purpose of fibroblast proliferation?
secrete tons of collagen around wound
What is scarring composed of?
collagen
Three D’s of wound cleaning
Remove debris
Debride the wound
Excise devitalized tissue
What should wound ideally be washed with?
normal saline
Best hemorrhage control
direct pressure and elevation
Which intention healing should gun shot wound be treated with?
tertiary intention (delay primary suture)
Timeframe of primary intention
usually suture if injury within 8 hrs
face, scalp, and neck wounds within 24 hrs
Reasons for secondary intention
Old wound Any infected, open wound Contamination Open wound with large tissue defect Abrasions Penetrating wounds (bites, stab)
Of non-absorbable sutures, _______ which are least reactive and result in least amount of scarring.
monofilament nylon
Prophylactic antibiotics for wounds
IM or IV 1st generation cephalosporin or penicillinase-resistant penicillin
if allergic Erythromycin or Cipro
When are antibiotics indicated for wound?
Lacerations with bone, cartilage, tendon, or joint injuries
Animal or human bites
Patients with artificial valves or other prosthetic devices (joint replacement)
