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. - remodelling-
collagen is remodelled and realigned along tension lines and cells that are no longer needed are removed by apoptosis
what patient factors affect healing capacity (10)
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 intention 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
while this is being done, skin tension is applied either side
where are neurovascular bundles located
superficial fascia
why dont you want to cut into neurovascular bundles
nerve damage, blood loss and delayed healing
ways to minimise blood loss
tourniquets
compression
packing
types of sutures
1- absorbable or non absorbable (less scarring)
2- monofilament or milutifilament (harbour bacteria)
3-dyed (dont use on skin) or undyed
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
surgeries for ligaments/capusle
released
repaired
plicated- tightening
semi rigid deformities often include
osteotomy - bone surgery to realign and also
soft tissue surgery to rebalance
pathologies for excision and biopsy
neuroma
ganglion
bursa
fibroma
nodule
tophi
lipoma
cyst
granuloma
what are ganglions
gelatinous fluid of mucopolysaccharides attached to joints or tendon sheaths
treatment for ganglions
aspiration, steroid injection, bible- LA and squeezing out fluid, surgery
complication with ganglions
can erode bode and be painful due to pressure on underlying structures
incision types for mortons neuroma (4)
dorsal- 3rd met space, usually heals quicker, hard to move through anatomy
websplitting- 3rd met space to toe web spaces, increased risk of infection
plantar linear- healing longer, better view of anatomy especially with stump neuroma, scarring on forefoot
plantar transverse- scarring on forefoot
conservative treatment for mortons neuroma
typically fail
neurectomy successful in 80-95%
what is a stump neruoma
when a mortons neuroma surgery is unsuccessful because pathology is left behind causing recurring symptoms
