Test 7 Hemostasis and Wound healing Flashcards
What are adhesions?
scar formation of the abdominal viscera
What is collagen?
main structural protein
What is a contracture?
scar tissue that lacks flexibility; causes constriction and pain
What is a cicatrix?
a scar
What is dead space?
separation of wound layers that have not been closely approximated or air that has become trapped between the layers
What is debridement?
the removal of devitalized tissue, debris, and foreign objects from a wound
What is dehiscence?
a separation of the edges of a surgical wound during healing
What is edema?
a large fluid volume in tissues between the body’s cells
What is an evisceration?
the protrusion of the abdominal viscera through the wound or surgical incision
What is extravasation?
movement of cells out of a blood vessel into tissue during inflammation
What is exudate?
fluid with a high content of protein and cellular debris that has escaped from the blood vessels and has deposited in tissues or on tissue surfaces, usually a result of inflammation
What is friable?
easily torn
What is gangrene?
decay or death of an organ or tissue caused by lack of blood supply. resulting from infection or inflammation
What is granulation tissue?
new connective tissue that forms on the surface of a wound when it is healing “proud flesh”
What is a granuloma?
mass of inflammed granulation tissue, usually associated with ulcerated infections
What is a hematoma?
a blood-filled space in tissue, the result of a bleeding vessel (blood clot)
What is hemostasis?
stopping the loss of blood
What is ischemia?
loss of blood supply to a body partWh
What is a keloid?
a hypertrophic scar, the scar may be bulbous and usually does not reduce over time
What is necrosis?
tissue death
What is a seroma?
mass or swelling caused by the localized accumulation of serum within tissue
What is serosanguinous?
exudate or discharge containing serum and blood
What is trauma?
physical injury
What is wound disruption?
separation of layers
What is the difference between incisional and excisional intentional wounds?
incisional- intentional cut to expose tissue
excisional- intentional cut to remove tissue or foreign material
What is occlusion banding?
Intentional wound
results from ischemia
used in hemorrhoid ligation
(skin tags)
What is a chemical wound?
Intentional wound
most uncommon
chemical placed on wound to denude/coagulate area
causes inflammation
used in plastic surgery
What are two classifications of unintentional wounds?
severity
mechanism of injury
What are traumatic wounds?
unintentional wound
sudden onset and severity
blunt
penetrating
burn
What is a closed wound?
unintentional
intact skin with underlying tissue damage
What is an open wound?
unintentional
integrity of skin destroyed
What is an abrasion?
mechanical irritation, scrape
(road rash)
What is an avulsion?
portion of skin and soft tissue partially or entirely torn away
What is a contusion?
bruise under the skin
skin intact but tissue below are damaged
usually black and blue
What is a crushed wound?
squeezed/ forced by pressure to alter or destroy tissue
What is an incised wound?
wound with smooth edges made by cutting device
may be contaminated or clean
-ex from a scalpel
What is a laceration?
torn wound with irregular edges
What is a puncture wound?
wound made with sharp pointed instrument
What is a perforation wound?
wound where an object enters and exits the body
What is a incidental wound?
iatrogenic wound
caused in surgery
What is a chronic wound?
persist for an extended time
can be due to infection
underlying physical condition: pressure sores or decubitus ulcers
What are the 4 classifications of wounds?
Clean
clean contaminated
contaminated
dirty/infected
Describe class 1 wound.
-clean wound
primary closure
no inflammation
no breaks
aerodigestive (does not enter respiratory, digestive, and GU tract)
Describe class 2 wound
-clean contaminated
open/ mechanical drainage
minor break in aseptic
no spillage from tracts
Describe class 3 wounds.
-contaminated
acute inflammation
major break in aseptic
less than 4 hours old
with spillage from tract
Describe class 4 wounds.
-dirty/ infected
perforated organs
microbial contamination present
more than 4 hours old
pus, may be present
What is first intention healing?
incision closed at surgery
approximated wound edges
no discharge/ infection
minimal scar formation
-heat/redness- increased blood flow
-swelling=edema large volume of fluid in area
-pain pressure on nerves
What are the three phases of first intention healing?
inflammatory response
proliferation
differentiation/maturation
Describe the inflammatory response phase.
Phase 1
lasts 3-5 days
exudate occurs
scab formation
leukocytes remove debris
fibroblasts reconstruct
no tensile strength
Describe the proliferation phase.
phase 2
day 3 to 20
fibroblasts multiply rapidly
25-30% tensile strength
new networks formed
Describe the differentiation/ maturation phase.
phase 3
post op day 14 to healed
good tensile strength
normal scar forms
What is second intention Healing?
called granulation
wound not closed
allows for healing from inside to outside
closes wound by contraction
longer healing time
risk of secondary infection
What is third intention healing?
wound left to heal but later closed by suture
infection at time of surgery
deeper/ wider scar
intermediate tensile strength
What is vacuum assisted closure device?
(VAC)
promotes healing by continuous suction/ pressure
used post op
2nd and 3rd intention healing
large traumatic wounds
Some Physical conditions of patients that affect wound healing are
Age
nutritional status
fluid balance
comorbidities
radiation exposure
immunocompromised
drug therapy
smoking
post op complications
physical activity
Intraoperative tissue handling of wound healing are
halstead principle
length of incision
direction of incision
duration of surgery
amount of tissue
elimination of dead space
tissue approximation
achievement of hemostasis
Aseptic and sterile technique od wound healing are
prevention of wound infections
reduce contamination
antibiotic therapy
wound irrigation
bowel technique
dressings
What are congenital hemostatic defects that affect hemostasis?
bleeding disorder
ex hemophilia (clotting factor)
What are acquired bleeding disorders that affect hemostasis?
caused by an outside source
examples: liver disease, anticoagulant therapy, and aplastic anemia
What are the 5 steps of clotting?
hemorrhage
platelet activation
clotting cascade
platelet stabilization
fibrinolysis
What device monitors blood loss?
Neptune
anesthesia monitors
surgeon documents
ABL= average blood loss
What are some of the mechanical methods of hemostasis
instruments
ligature
clips
sponges
pedgets
bone wax
pressure
tourniquet
What are some of the thermal methods of hemostasis?
ESU
lasers
argon plasma coagulation
ultrasonic scalpel
tissue sealing devices
What is the coagulant method of hemostasis?
promotes blood coagulation
administered systemically or applied topically
What are the systemic hemostatic agents?
Calcium gluconate
calcium chloride
calcium lactate
Vitamin K
protamine sulfate
What is gelfoam?
(surgifoam)
absorbable
may be moistened with saline, thrombin, epi, solution
absorbed in 30 days
