wk 7- podiatric surgery Flashcards
phases of wound healing
- haemostasis
- within minutes post injury. platelets aggregrate at the site of injury to form a fibrin clot - inflammatory
- bacteria and debris are phagocytosed and removed, and factors released that cause the migration and division of cells involved in proliferative phase - proliferation-
angiogenesis, collagen deposition, granulation tissue formation, epithelialisation and wound contraction. - rmodelling-
collagen is remodelled and realigned along tension lines and cells that are no longer needed are removed by apoptosis
what factors affect healing capacity
age
nutrition status
blood supply
dehydration
chronic disease
immune response
radiation therapy
tissue quality
revision/infection
compliance
layers of the epidermis
stratum basale.
stratum spinosum.
stratum granulosum.
stratum lucidum.- not in thin skin
stratum corneum.
primary wound healing
immediately sealing wound with suture, skin graft or flap closure
secondary wound healing
no sealing of wound
wound closed by re-epithelisation and contraction, some scar tissue
healing is slower
tertiary wound healing
delayed primary closure
surgical intervention after repeated debridement and antibiotic therapy
mixture of secondary and primary wound healing
what are relaxed skin tension lines and what are they used for
creases in the skin that develop with normal flexion and exension of joints, incision parallel to these lines helps with healing and less scarring as those areas are under less stress
how should incision be done
vertical to the skin using the tip of the blade and using the belly of the blade to cut
why dont you want to cut into neurvascular bundles in superficial fascia
nerve damage, blood loss and delayed healing
ways to minimise blood loss
tourniquets
compression
packing
types of sutures
- absorbable - clear
- non absorbable- blue/black
stitching for tendons and ligaments, sometimes skin- dependent on the amount of strength required of the suture
they cause less scarring but need to be removed
needles for suturing (3 points to it)
point
body
swage- where the needle is camped to suture
what are steri strips
alternative to suturing
okay for low tension wounds
soft tissue surgery can be used for
flexible and semi flexible deformity where soft tissue requires some rebalancing
surgeries for tendons
tenotomy- tendon cut
tenectomy- removal of tendon
lengthening
transfer
reroute