The Wounds Flashcards
- Loss of skin on the body as a result of trauma or injury is called
“Wound‟
Partial loss of skin is called
“Abrasions‟
Traumatic wounds are classified mainly in two categories which forms the basis of management. They are:
- Tidy wound, such as clean incised wounds.
- Untidy wounds, such as lacerated wounds.
Another classification in four categories is based on the status of contamination of surgical sites.
- Clean wounds
- Clean contaminated wounds
- Contaminated wounds
- Dirty wounds
Clean wounds - when no viscous is opened
Clean wounds
- when viscous is opened but with minimal spillage of its contents
Clean contaminated wounds
- when spillage is from inflamed viscous
Contaminated wounds
- which are clearly infected
Dirty wounds
Clean wounds can be cleaned, dried, closed and sealed by?
dressings
Most surgical patients have wounds. Wounds require dressings. Clean wounds can be cleaned, dried, closed and sealed by dressings.
- Clean contaminated and oozing wounds should not be closed or sealed. They should be allowed to breathe and ventilate through porous dressings; they may require frequent dressings.
require cleaning, de-sloughing and debridement, till they become clean. Wounds contaminated with dirt, dust and soil require tetanus prophylaxis
Dirty wounds
close by themselves slowly. Epithelium grows at an average rate of 1mm per day; hence large wounds may take a long time to close. They may either be closed by sutures or clips and staples; or may be covered by skin grafts.
Healthy small wounds
- Healthy wounds are closed by?
primary suturing
unhealthy wounds are closed by secondary suturing or delayed closure after they are rendered healthy.
unhealthy wounds
Sutures, clips in wounds along stress lines and in vascular areas can be removed between _____days
3-7 days
Sutures, clips in wounds along stress lines and in vascular areas can be removed between 3-7 days. Those across the lines must be left for ______ weeks.
2-3 weeks
heal by primary intention; that is by regeneration of epithelium and minimum repair by fibrous tissue. They leave minimum scar.
Clean wounds
- Wounds along stress lines in body [Langer‟s lines] heal faster with minimum scar. Those across these lines take longer time to heal and leave ugly scars.
Wounds start gaining strength from ______ day onwards. They are strong enough to withstand normal stress within ______ weeks. However, remodeling and further gaining of strength continues for up to ________ months.
3rd
two weeks
6 months
All wounds, when they heal, leave _________.
scars
is fibrous tissue, covered by epithelium
Scar
All scars are deficient, devoid of nerves and vessels. Most of them are symptomless and fade away with time. In some cases scar may become hypertrophied and give an unpleasant cosmetic appearance; however this hypertrophy remains confined to the scar. Such scars may need revision.
is a complication of scar
Even a small scar of ear piercing can lead to outgrowing of this.
mainly grow outwards, are only disfiguring, and have minimal symptoms. Other type grows inwards and extends beyond the scar, deep into the tissues and has symptoms like severe itching and burning pain. It has racial and genetic tendencies. Recurrence, even after extensive excision is common.
Keloid
occurs due to trauma or during operations, and must be stopped. Reactionary hemorrhage is the term used for early hemorrhage in post trauma/operative period when collapsed small vessels open up following resuscitation, and start to bleed.
Primary haemorrhage
occurs in infected wounds when blood vessels are eroded by inflammatory process. Similar measures will work in both these situations. As first aid, in hemorrhages of extremities, elevation of the limb above the level of heart, direct compression on the bleeding area can be effective. Temporary proximal compression by bands or tourniquet can also be used; however it must be released intermittently so as not to cause distal ischaemia. Finally the bleeding points may have to be ligated or sutured.
Secondary hemorrhage
Spontaneous bleeding in skin and mucous membranes is called
Ecchymosis
Bleeding and extravasations of blood in tissues due to injury or trauma is called
Bruise or Contusion.
In these conditions, blood is diffusely spread and cannot be drained.
Bruise or Contusion
Collection of blood in tissues is called
Haematoma
are the commonest pathology dealt by surgeons. It is considered as a major complication in surgery.
Infections
3 Surgical Infections
- Surgical site infections [SSI],
- Nosocomial infections, and
- Cross infections.
usual organisms in surgical infections
Staphylococci
streptococci
E. Coli, proteus
pseudomonas
anaerobes
produce localized necrotizing inflammations and may end in collection of thick pus, due to their coagulase positive nature. Abscesses, boils, carbuncles, are examples of such lesions.
Staphylococci
is an infected hair follicle and is self limiting condition. It may spread and become an abscess, requiring drainage.
Boil or furuncle
is infection of many hair follicles in a group at one place, and occurs usually on nape of neck or on back. It is common in diabetics. It is common in diabetics.
Carbuncle
Wide excision and drainage maybe required in addition to control of diabetes and infection.
produce spreading lesions due the presence of enzyme hyaluronidase. Examples are erysipalas, cellulitis, fasciitis and myositis.
Streptococci
. Blue or green pus indicates _______ infection
pseudomonas infection
foul smelling pus indicates presence of
anaerobes
is spreading inflammation of subcutaneous tissues. Antibiotics are required
Cellulitis
In humans ________ presents as red streaks in white skinned people; difficult to see in dark skin ones.
Lymphangitis
is inflammation of superficial veins and may follow as complication of venipuncture. Treatment is conservative.
Thrombophlebitis
is localized collection of pus.
Abscess
Abscess is usually caused by _______, mixed organism may be present. Fluctuation can be elicited in superficial abscesses. Deep ones require ultrasound to diagnose.
staphylococcus
is digestive product of dead and dying bacteria, blood cells and local tissue.
Pus
Pus, wherever it is, must be removed, by aspiration or drainage. All acute abscesses require drainage. Dead tissue must be desloughed, and thick fibrotic edges must be debrided to promote healing in chronic wounds and ulcers.
Pus, wherever it is, must be removed, by aspiration or drainage. All acute abscesses require drainage. Dead tissue must be desloughed, and thick fibrotic edges must be debrided to promote healing in chronic wounds and ulcers.
These are neoplastic growths that present as swellings or ulcers. In most cases, cause is unknown; although recent research in molecular biology and genetics is trying to unravel this mystery.
Tumors
Tumors are either:
a. Benign
b. Malignant
where growth is very fast
Malignant
which are usually capsulated and grow slowly
Benign
Most have high potential for malignant change
benign tumors
are the result of uncontrolled growth of tissues by cellular hyperplasia, dysplasia and anaplasia. These are either epithelial in origin [Carcinomas], or mesothelial [Sarcomas]
Tumors
epithelial in origin
epithelial in origin
mesothelial
Sarcomas
have no capsule; they grow and spread by infiltration in surrounding tissues. Once vessels are infiltrated, lymphatic or blood spread occurs.
Carcinomas
In the abdomen cancers can spread all over the peritoneal surface by freely falling malignant cells, called
trans-coelomic spread.
usually grow by expansion, and spread by blood stream.
Sarcomas
Histologically carcinomas may be well differentiated in their cellular structure and glandular pattern; moderately differentiated, or completely undifferentiated when they are called ________-
Anaplstic
This last group has the poorest prognosis.
Anaplstic
umors of endocrine glands may involve more than one gland of Neuro-Endocrine origin. These are called
Multiple Endocrine Neoplasia (MEN)
is the treatment of choice for Benign Tumors, if they are bulky, unsightly, causing symptoms, changing their growth pattern, or are known to be premalignant.
Surgical excision
is the treatment of choice for most Malignant Tumors in early stage.
Radical curative surgery
is required to relieve symptoms in advanced tumors which are not curably resectable
Palliative surgery
Certain tumors respond to cancer chemotherapy, either completely as in lymphomas; or partly, when tumor size and its stage can be reduced. This is called _________therapy, and is followed by surgical excision.
neo-adjuvant therapy
In other instances _________ is used as adjuvant therapy after surgery, to deal with any remaining cancer cells. It can also be the only therapy in advanced tumors.
chemotherapy
is indicated in such radio-sensitive tumors; pre-operative, post-operative, or as the sole treatment.
Radiotherapy
. At times both chemotherapy and radiotherapy are combined to enhance the anti tumor effect; it is then called
Chemo-radiation
are abnormal swellings containing air or fluid; clear thin or turbid & thick.
Cysts
are lined by epithelium
True cysts
have no epithelial lining
False cysts (Pseudo-pancreatic cyst)
Examples are Branchial cyst, Thyroglossal cyst, Duplication cyst, Mesenteric cyst, Polycystic disease of liver, kidneys, pancreas, lungs, etc.
Developmental cysts:
Example, Cystic Hygroma. Sequestration cysts: Sequestration Dermoids. Germinal cysts: These arise from germinal layers and are common in testes and ovaries in the form of Dermoids and Teratomas.
Malformation cysts
When ducts of small glands are blocked, secretions are retained forming a cystic swelling. Examples are epidermal cysts and ranula.
Retention cysts:
When secretions in the acini of a ductless gland accumulate, they distend the acini forming cysts. Example is colloid cyst of thyroid gland.
Distention cysts
are also due to distension of alveoli with air.
Pulmonary cysts
Solid masses may undergo ischaemic necrosis and degeneration in their center leading to cyst formation. Example is chocolate cysts of ovary.
Degeneration cysts:
A penetrating foreign body may implant a tiny piece of dermis in subcutaneous tissue causing sub-minimal aseptic inflammatory reaction and cyst formation called implantation dermoid cyst.
Implantation cysts:
Classical example is hydatid cyst. Parasite causes lesions where germinal layer secretes fluid leading to formation of cyst and floating daughter cysts which look Common Lesions of Skin and Subcutaneous Tissue Simple Benign Lesions Epidermal cysts, earlier called sebaceous cysts, are the commonest.
Parasitic cysts
Skin and Subcutaneous Tissue Simple Benign Lesions Epidermal cysts, earlier called _______, are the commonest
sebaceous cysts
They arise from sebaceous glands and occur in hairy areas such as scalp, scrotum, chest, etc. They are attached to the skin as a black spot from where the hair fell. They contain thick cheesy sebum. Complications include infection, ulceration, and rarely the sebaceous horn. Small ones can be left alone. Large, unsightly or infected ones require excision. Recurrence is common like grapes.
Parasitic cysts
is merely a part of the holistic management of a patient
operation
Peri-operative care includes
pre-operative preparation
intra-operative care
post-operative complications and their management
This starts with obtaining “Informed consent‟ of the client and by evaluating the risk status of the patient like coexisting medical conditions, medications if any, and current haemo-dynamic and cardio-respiratory status.
Preoperative Preparation
is postponed till near normal physiological state is achieved. Special preparations may be required before surgery, depending on the procedure, such as bowel preparation, exchange transfusion, etc.
Elective surgical procedure
high risk consent is taken and critical care monitoring is initiated.
emergency surgery
This includes guaranteeing a near normal physiological status of the patient while asleep, as well as after coming out of the effects of anaesthesia. It is important to keep a constant surveillance on monitoring screens, checking vital signs; pulse, respiration, blood pressures and body temperature
Intra-Operative Care
recognizes developing complications, if any, in time and takes steps to deal with them. In many situations surgeon has to use drains. Their function is to remove undesirable collections. Once drainage stops, drains can be removed.
Postoperative care
is the most common cause of wound dehiscence in surgical wound.
Infection
Few common causes of Wound dehiscence include poor nutrition, poor closure and excessive intra-abdominal pressure.
