Suturing and Wound Healing

Question 1

In which type of wounds does primary intention healing occur? Give an example. What is the end result?

Answer 1

Wounds with dermal edges close together
e.g a scalpel incision
Complete return to function + minimal scarring

Question 2

What will a suture that is too loose lead to?

Answer 2

wound edges will not be properly opposed, limiting the primary intention healing + reducing wound strength

Question 3

What will a suture that is too tight lead to?

Answer 3

blood supply to the region may become compromised + lead to tissue necrosis + wound breakdown

Question 4

In which type of wounds does secondary intention healing occur? Give an example. What is the end result?

Answer 4

when the sides of the wound are not opposed, therefore healing must occur from the bottom of the wound upwards.

Question 5

What causes keloid scars? Who is particularly susceptible? What type of healing do these occur in?

Answer 5

Excessive collagen production, leading to extensive scarring.
Dark skinned people
Both primary + secondary intention

Question 6

List 5 local factors that can effect wound healing

Answer 6

Type, size + location of wound
Local blood supply
Infection
Foreign material or contamination
Radiation damage

Question 7

List 4 systemic factors that can effect wound healing

Answer 7

Increasing age
Co-morbidities esp. CV disease or DM
Nutritional deficiencies esp. Vit C
Obesity

Question 8

What are surgical site infections?

Answer 8

Infections that gain entry to the body via a surgical environment.

Question 9

What is classed as clean surgery?

Answer 9

Elective, non-emergency, non-traumatic, + primarily closed, with GI, biliary, + GU tracts remaining intact

Question 10

What is classed as clean-contamination in surgery?

Answer 10

Urgent or emergency case that is otherwise clean
Elective opening of respiratory, GI, biliary, or GU tract with minimal spillage + not encountering infected urine or bile

Question 11

What is classed as contamination in surgery?

Answer 11

Gross spillage from GIT or entry into biliary or GU tract (in presence of infected bile or urine)
Penetrating trauma <4 hours old or a chronic open wound to be grafted or covered

Question 12

What is classed as dirty contamination in surgery?

Answer 12

Purulent inflammation (e.g. abscess)
Preoperative perforation of respiratory, GI, biliary, or GU tract, or a penetrating trauma >4 hours old

Question 13

What are the 4 stages of wound healing?

Answer 13

Haemostasis
Inflammation
Proliferation
Remodelling

Question 14

What type of procedure is suturing?

Answer 14

Sterile

Question 15

What are the benefits of primary intention healing?

Answer 15

Time to closure is short which reduces risk of infection Scarring is limited

Question 16

How does secondary intention healing differ from primary?

Answer 16

Takes longer
Produces a larger scar; not necessarily weaker
Produces more late contraction