WH 2 Flashcards
Classification of Wound INfections that involves skin and subcutaneous tissue onlly. Edematous, erythematous and tender, post-op low grade fever
Superficial Incisional
Arise immediately adjacent to the fascia, either above or below it, and often have an intraabdominal component
Deep incisional
Most dangeous of deep infections. It is a septic thrombosis of the vessels between the skin and the deep layers. High fever, tachycardia and marked hypovolemia, cardiovascular collapse with treatment high dose penicillin (20-40 million U/d IV); removal of necrotic tissue
Necrotizing fascciitis
Wounds that have failed to proceed through the orderly process that produces satisfactory anatomic and functional integrity or that have preceeded through the repair process without producing an adequate anatomic and functional result 4 weeks of failed wound healing
Chronic Wounds
The presennce of bacteria without multiplication:
Multiplication without host response:
The presence of host response in reaction to desposition and multiplication of bacteria
- Contamination
- Colonization
- Infection
These wounds occur due to a lack of blood supply and are typically extremely painful in px with pure ischemic ulcers ass. w/ other symptoms of peripheral vascular disease (history of intermittent claudication, rest pain, and color or trophic changes) the wound usually is shallow with smooth margins and a pale base and surrounding skin may be present. Management is removal of restrictive stocking (in px with critical ischemia), frequent repositioning and surveillance
Ischemic Arterial Ulcers
Ulcer that fails to reepithelialize despite the presence of adequate granulation tissue in a px w/ skin color changes in the area of ulceration and signs of venous hypertension. Venous insufficiency can be due to any combination of deep, superficial and perforator vein valvular reflux brownish pigmentation of skin combined with the loss of subcutaneous fat produces characteristics changes (lipodermatosclerosis) tend to occur at the sites of incompetent perforators (e.g. above the medial malleolus, over Cockett’s perforator)
Venous Statis Ulcers
Management of this disease is
- compression therapy (rigid, zinc oxide-impregnated, nonelastic bandage or a foul-layered bandage approach)
- wound care
- vasoactive substances
- growth factor application
- skin substitutes
Venous Static Ulcers
Motor neuropathy
Charcot’s foot
Management of this disease includes:
- local and systemic measure
- achievement of adequate blood sugar level
- antibiotics
wide debridement of necrotic or infected tissue
- off-loading of the ulcerated area (specialized orthotic shoes/casts)
- PDGF and granulocyte-macrophage colony-stimulating factor
- application of engineered skin allograft substitues
- foot care
Diabetic Wounds
A localized area of tissue necrosis that develops when soft tissue is compressed bet. a bony prominence and an external surface. It is accelerated in the presence of friction, shear forces, and moisture. COntributary factors inclulde immobility, altered acitvity levels, altered mental status, chronic conditions, and altered nutritional status
Decubitus or pressure ulcers
4 Stages of Pressure Ulcer Formation Stage I: Stage II: Stage III: Stage IV:
Stage I: no blanching erythema of intact skin
Stage II: partial-thickness skin loss involving epidermis or dermis or both
Stage III: full-thickness skin loss, but not through the fascia
Stage IV: full-thickness skin loss with extensive involvement of muscle and bone
Management of this disease includes:
- wound care
- debridement of all necrotic tissue
- maintenance of a favorable moist wound environment that will facilitate healing
- relief of pressure
- addressing host issue (nutritional, metabolic and circulatory status)
Decubitus or pressure ulcers
The clinical manifestions off exuberant (excess) healing are protean and differ in the:
- Skin (mutilating or debilitating scars, burn cotractions)
- Tendons (frozen repairs)
- GI tract (strictures or stenoses)
- Solid organs (cirrhosis, pulmonary fibrosis)
- Peritoneal cavity (adhesive disease)
Rise above the skin level but stay within the confines of the original eound and often regress over time
Hypertrophic scars (HTSS)
Rise above the skin level as well but they extend beyond the border of the original eound and rarely regrees spontaneously
Keloids
Fibrous bands of tissues formed between organs that are normally separated and/or between organs and the internal body wall. It usually a result of peritoneal injury, either by a prior surgical procedure or due to intr-abdominal infection. Leading cause of secondary infertility in women and can cause substantial abdominal and pelvic pain
Peritoneal Adhesions
Prevention of Peritoneal Adhesions
- Careful tissue handling, avoiding desiccation and eschemia, and spare use of cautery, laser and retractors
- Use of barrier membranes and gels
Places directly on the wound and may provide absorption of fluids and prevent desiccation, infection and adhesion of a secondary dressing
Primary Dressing
Placed on the primary dressing for further protection, absorption, compression, and occlusion
Secondary Dressing
Conventional skin grats that consist of epidermis plus part of the dermis
Split (partial) thickness grafts
Conventional skin grafts that retain the enttire epidermis and dermis
Full-thickness grafts
Conventional skin grafts that transplants from 1 site on the body to another
Autologous grafts (autografts)
Conventional skin grafts that transplant from a living nonidentical donor or cadever to the host
Allogenic grafts (aloogratfs, homografts)
