Week 5: General Surgery

Question 1

What are the stages of wound healing?

Answer 1

Inflammatory
Proliferative
Maturation

Question 2

What is the inflammatory stage of wound healing?

Answer 2

• begins with surgical incision or injury
  
  • continues for 4 – 5 days
  • classic signs of inflammation
  • increased blood supply to tissue
  • leukocytes and other cells dissolve and remove debris – preparing site of repair phase
  • no wound strength – relies on sutures

Question 3

What is the proliferative stage of wound healing?

Answer 3

Starts around day 3
Fibroblasts form collagen matrix – granulation tissue
Fills with new blood vessels – tissue bright beefy red – lots of nutrients and oxygen brought to site
Wound contraction occurs – varies depending on site

Question 4

What is the maturation stage of wound healing?

Answer 4

Starts approx 21 days and can last up to 1 year
Collagen production continues and is thicker, providing added tensile strength
Excess collagen is eventually reabsorbed and scar looks pale
Suture line contracts and whole scar is remodelled
Final scar dependent on initial granulation tissue

Question 5

What are the types of wound healing?

Answer 5

Primary intention
Secondary intention
Delayed primary intention

Question 6

What is a primary intention?

Answer 6

Clean incision
Surgical incision is best example
Wound approximated with sutures/clips or steri strips
Minimal scarring

Question 7

What is a secondary intention?

Answer 7

Wound breakdown caused by infection, poor suture technique
Traumatic wound, tissue loss ++ or pressure ulcer
Wound often left open
Granulation from inner layers outward occurs
Slow process
Scarring ++ - poor cosmetic effect

Question 8

What is a delayed primary intention?

Answer 8

Considered the safest way to treat contaminated, infected, traumatic wounds where tissue loss is great
Debridement of non viable tissue
Wound left open and packed/VAC dressings etc
May be left to heal by 20 intention

OR

When no further evidence of infection – wound can be approximated with sutures or steri strips

Question 9

What are factors affecting wound healing?

Answer 9

Type of wound – clean vs dirty
Infection
Co morbidities
	- poor blood supply
	- diabetes
	- malignancy
 	- renal disease
Nutrition 
Old age
Dead space

Question 10

What are the muscles of the abdominal wall?

Answer 10

External oblique

Internal oblique

Transversus abdominus

Rectus abdominus

Question 11

What is aponeurosis?

Answer 11

– broad sheets of fascia (connective tissue) formed at edges of muscle

• like thin tendons
• joins muscles to other structures eg bone and cartilage