Wk 9 Flashcards
Name the six goals of wound care?
1) reduce ecchymoses
2) reduce “dead space”
3) prevent hematoma and seroma formation
4) prevent infection
5) preserve function
6) preserve appearance.
What are the seven complications of wound healing?
1) ecchymoses
2) hematomas
3) seromas
4) infections
5) wound dehiscence
6) bad scarring
7) loss of function
What are the causes of ecchymoses? How can we reduce their severity?
Cause: blood leaks into the skin and often in a thin layer into the SubQ fat. Reduce severity: careful handling of tissues during surgery and repair, avoid use of excessive volume of local anesthesia, proper pressure bandaging for 24 hours, intermittent ice packs for 2-3 days.
What causes hematomas?
Post-op sustained capillary bed leakage or venous/arterial bleeding from the raw surface of the surgical site or within a traumatic lesion.
What pre-operative steps can be taken to reduce the occurrence of hematomas?
1) assess each pt’s general health status and history of coagulopathies
2) identify any history of significant bleeding during prior low-risk surgical or dental procedures
3) identify common medical problems such as renal dysfunction, hypertension, liver disease, and abnormal coagulation which may affect healing.
4) screen for alcohol abuse, which impairs coagulation of platelets and decreases vasoconstriction.
5) identify all medications that patient takes both daily and prn and the last date taken.
T or F: aspirin, alka-seltzer, ibuprofen, and clopidogrel (plavix) have been shown to increase risk of hemorrhage more than warfarin.
TRUE
T or F: all prescribed and non-prescribed anticoagulants must be stopped 1 week prior to dermatologic surgery.
FALSE
What intraoperative steps can be taken to reduce bleeding and hematomas?
Pay attention to careful surgical hemostasis, use “quilting” sutures to tie off “bleeders”, place drains when needed, choose quickclot or surgicel gels
What post-op management steps can reduce bleeding and hematomas?
Apply pressure bandaging: for 24 hrs post-op excisional surgeries, apply ice packs over dressing for 20 mins q 4-6 hrs for pts on anticoagulant medications or who have excessive bleeding during surgery, consider prolonged use of drains and “suction” drains.
Contrast the treatments for expanding or clotted hematomas compared to fluctuant ones.
Expanding/clotted:
1) partially or completely re-open the wound
2) identify culprit
3) stop bleeding by suture ligation or electrosurgery
4) do a full-layer re-closure
5) insert a drain if seems indicated
6) if there is a high risk of more bleeding or the wound is contaminated let the wound heal by second intention! Fluctuant/liquefied:
1) aspirate – use large needle
2) repeat daily until hematoma stops forming
3) continue using pressure bandaging.
Does prophylaxis with antibiotics for routing or elective MS generally lower the risk of infection?
Studies show prophylaxis with antibiotics for routine or elective procedures actually increases the risk of infection! Single reliable study showing an advantage to prophylactic oral antibiotic use of PCN for intraoral wounds.
What are current guidelines for withholding antiplatelet drugs and other anticoagulants?
In each case weigh the real and increased risk of bleeding with the lower but potentially life-threatening risk of thrombotic event if an anticoag is temporarily discontinued. Delay surgery for three days after the last dose of aspirin, continue warfarin or plavix to avoid thrombotic events, avoid non-medically necessary supplements/anticoagulants for 1 week
Prophylactic antibiotics are indicated in patients with traumatic wounds in what three situations?
1) prosthetic heart valve
2) Hx of infective endocarditis
3) Congenital Heart Disease : unrepaired cyanotic CHD; completely repaired congenital heart defect w/prosthetic material or device during first 6 months after procedure; repaired CHD with residual defects at the site or adjacent to the site of prosthetic patch or prosthetic device; cardiac transplant recipients with cardiac valvular disease.
What are the arguments against using antibiotics in traumatic wounds?
limited indications for the routine use of antibiotics in lacerations, – there is a single reliable study showing an advantage to prophylactic oral antibiotic use of PCN for intraoral wounds, – clean, properly debrided early traumatic wounds in patients that are not immune compromised do not require prophylactic antibiotics. Studies show prophylaxis with antibiotics for routine or elective procedures actually increase the risk of infection.
T or F: wounds can not dehisce as long as sutures are in place.
False
