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SURGERY > WH 2 > Flashcards

WH 2 Flashcards

1
Q

Classification of Wound INfections that involves skin and subcutaneous tissue onlly. Edematous, erythematous and tender, post-op low grade fever

A

Superficial Incisional

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2
Q

Arise immediately adjacent to the fascia, either above or below it, and often have an intraabdominal component

A

Deep incisional

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3
Q

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

A

Necrotizing fascciitis

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4
Q

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

A

Chronic Wounds

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5
Q

The presennce of bacteria without multiplication:
Multiplication without host response:
The presence of host response in reaction to desposition and multiplication of bacteria

A
  • Contamination
  • Colonization
  • Infection
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6
Q

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

A

Ischemic Arterial Ulcers

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7
Q

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)

A

Venous Statis Ulcers

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8
Q

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
A

Venous Static Ulcers

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9
Q

Motor neuropathy

A

Charcot’s foot

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9
Q

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

A

Diabetic Wounds

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10
Q

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

A

Decubitus or pressure ulcers

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11
Q 
4 Stages of Pressure Ulcer Formation
Stage I:
Stage II:
Stage III:
Stage IV:
A

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

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12
Q

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)
A

Decubitus or pressure ulcers

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13
Q

The clinical manifestions off exuberant (excess) healing are protean and differ in the:

A
  • Skin (mutilating or debilitating scars, burn cotractions)
  • Tendons (frozen repairs)
  • GI tract (strictures or stenoses)
  • Solid organs (cirrhosis, pulmonary fibrosis)
  • Peritoneal cavity (adhesive disease)
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14
Q

Rise above the skin level but stay within the confines of the original eound and often regress over time

A

Hypertrophic scars (HTSS)

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15
Q

Rise above the skin level as well but they extend beyond the border of the original eound and rarely regrees spontaneously

A

Keloids

16
Q

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

A

Peritoneal Adhesions

17
Q

Prevention of Peritoneal Adhesions

A
  • Careful tissue handling, avoiding desiccation and eschemia, and spare use of cautery, laser and retractors
  • Use of barrier membranes and gels
18
Q

Places directly on the wound and may provide absorption of fluids and prevent desiccation, infection and adhesion of a secondary dressing

A

Primary Dressing

19
Q

Placed on the primary dressing for further protection, absorption, compression, and occlusion

A

Secondary Dressing

20
Q

Conventional skin grats that consist of epidermis plus part of the dermis

A

Split (partial) thickness grafts

21
Q

Conventional skin grafts that retain the enttire epidermis and dermis

A

Full-thickness grafts

22
Q

Conventional skin grafts that transplants from 1 site on the body to another

A

Autologous grafts (autografts)

23
Q

Conventional skin grafts that transplant from a living nonidentical donor or cadever to the host

A

Allogenic grafts (aloogratfs, homografts)

24
Q

Conventional skin grafts that are taken from another species (e.g.porcine)

A

Xenogenic grafts (heterografts)

25
Q

Skin Substitute:

Advantages:

  • NO biopsy needed
  • off the shelf availability
  • provide wound coverage
  • promote healing

Disadvantages:

  • Unstable
  • Does not prevent wound contracture
  • Inadequate cosmesis
  • Possibility of disease transmission
  • Fragile
A

Cultured allogeneic keratinocyte graft

26
Q

Skin Substitute:

Advantages:

  • Prevents contracture
  • Good prep for graft application

Disdvantages:

  • Limited ability to drive reepithelialization
  • largely serves as temporary dressing
A

Bioengineered dermal replacement

27
Q

Skin Substitute:

Advantages:

  • More closely mimics normal anatomy
  • DOes not need secondary procedure
  • Easily handled
  • CAn be sutured, meshed, etc.

Disadvantages:

  • Cost
  • Short shelf-life
  • True engraftment questionable
A

Cultured bilayer skin equivalent

28
Q

Autologous growth factors are harvested from the px’s own platelets, yielding an unpredictable combination and conc. of factors, w/c are then applied to the wound. PLatelet-derived growth factor BB (PDGF-BB) is currently approved by the FDA for Tx of diabetic foot ulcers

A

Growth factor therapy

29
Q

Gene delivery to wouunds includes traditional approaches such as viral vectors and plasmid delivery or, electroporation and microseeding

A

Gene or Cell Therapy

30
Q

Supplemental oxygen therapy was used to improve healing and both local oxygen therapy and systemic therapy were used for that purpose

A

Oxygen Therapy in WH

31
Q

Is term used for the bacterial growth on a chronic wound that is encapsulated by a protective layer made up of the host and bacterial proteins.

A

Biofilms

32
Q

3 Stages of Biofilm

A
  • Reversible bacterial adhesion stage
  • Permament adhesion or maturation stage
  • Secretion of a surrounding protective matrix- extracellular polymeric substance (EPS)

SURGERY (9 decks)

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