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Surgery > Wound > Flashcards

Wound Flashcards

1
Q

What are main types of wounds (3)?

*just name

A
  • incisional
  • lacerations
  • burns
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2
Q

What are incisional wounds caused by?

A

Shar objects e.g. knife (either traumatic or surgical)

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3
Q

What causes laceration?

What happens in laceration?

A

Laceration

Cause: an injury with blunt objects -> skin tear

What happens: Stretch of the skin -> tear of the dermis and underlying vessels

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4
Q

What’s degloving?

A

degloving -> It’s a type of laceration

Skin is removed from underlying fascia by a rotational force

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5
Q

Types of burns (3)

A

Burns:

  • thermal
  • electrical
  • chemical
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6
Q

General approaches to the treatment of the burns:

A. superficial

B. deep

A

Superficial burns -> conservative management

Deep burns -> possibly specialist input

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7
Q

What are Langer’s lines?

A

Langer’s lines are the areas of tension of the normal skin

* surgical incisions should be made along these lines

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8
Q

What’s the deep wound?

What management do we need in case of deep wound?

A

Deep wound - cross dermis and pass into subdermis

Surgical closure is required in terms of deep wounds

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9
Q

Two physiological ways that a wound can heal

A

Healing of the wound (physiological)

A. Primary intention -> two edges of skin are brought together -> healing occurs rapidly

B. Secondary Intention -> two wound edges cannot be brought together *or are left open for the purpose; the wound is kept clean and granulation tissue forms in the gap -> this fills the space and secondary intention healing occurs

*sepsis, swelling

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10
Q

Factors that promote healthy wound healing (5)

A
  • no infection
  • no foreign body
  • good blood supply
  • appropriate skin apposition (alignment)
  • no excess tension to the wound
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11
Q

General types of sutures (2) - just mention what types and describe (advantages, disadvantages)

A

- absorbable -> biological; broken down by enzymes; they do not need to be removed although they provide support only for limited period of time

  • non - absorbable -> are non-biological materials; they provide permanent wound support but need to be removed and there is also a potential for a foreign body reaction and infection
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12
Q

When to remove:

  • superficial sutures
  • facial sutures
A
  • superficial sutures (if on the limbs) -> remove after 10 days
  • if on the face -> remove after 5 days
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13
Q

Name an example (1) of absorbable sutures

A

Polyglactin

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14
Q

What to use Steri-strips for?

A

Steri- strips

Used in closure of small skin wounds e.g. superficial arm wound and non-gapping scalp injuries

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15
Q

What do we often use tissue glue for?

A

Superficial scalp wounds

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16
Q

Metal clips

  • what are they used for?
  • how long for?
A

Metal clips - remain large metal staples

Use: large abdominal and thoracic surgery

  • kept on for 10 days
17
Q

When the wound of the scalp can be managed with tissue glue and when with sutures?

A

If the wound will cross aponeurosis -> needs suture closure

*aponeurosis lies under the fat and fibrous layer

18
Q

What can delay wound healing?

A
  • infection
  • foreign body
  • steroids -> as collagen synthesis and cytokine function is inhibited
  • tissue hypoxia, bad blood supply and respiratory failure
  • systemic disease: jaundice, DM, cancer and malnutrition
  • previous radiation to damage area
  • sepsis
  • poor surgical technique

-

19
Q

Exogenous organisms causing wound infection (2)

A
  • Staphylococcus aureus

- Staphylococcus epidermis

20
Q

Examples of endogenous organisms causing wound infection after bowel surgery

A

endogenous wound infection -> usually gut organisms after bowel surgery

    • E. coli*
    • Klebsiella*
    • Proteus*
    • Pseudomonas*
    • Bacteroides*
    • Clostridia spp.*
  • -* anaerobic streptococci
21
Q

Examples of urinary pathogens causing wound infection after open urology (2)

A
  • E. coli
  • enterococci
22
Q

Examples of vaginal pathogens causing wound infection after gynaecological operations (2)

A
  • anaerobic or aerobic streptococci
  • yeats
23
Q

What is the management of infected surgical wounds?

A

Wounds should be:

  • opened
  • washed out with either surgical toilet or debridement
  • dressings changed regularly
  • antibiotics given in accordance to the wound swabs (culture and sensitivity)
24
Q

Wound dehiscence:

  • following what types of surgery
  • what happens
  • risk factors
A

Wound dehiscence = rupture against the surgical incision

Types of surgery: 2- 10% abdominal wounds

What happens: wound breaks down completely

e.g. laparotomy wound dehiscence -> loop of bowel is exposed

Risk factors (when does it occur): wound infection, the suture may tear through the weak tissue (steroid use, elderly, malnutrition, malignancy)

25
Q

Management options for wound dehiscence

A

Patient must be returned to the theatre and either:

  • the wound would be sutured back
  • healing would be allowed by secondary intention (gap left for the granulation tissue to form)
  • open laparotomy -> in cases of severe sepsis or fistula
26
Q

Incisional hernia

  • whan does it happen
  • what happens
  • risk factors
A

Incisional hernia

  • it is late post-op complications
  • wound closure becomes infected -> abdominal/ visceral content protrudes through the wound closure site
  • risk factors: malnourished, elderly, obesity, poor surgical technique
27
Q

What is the purpose of drain?

A

Drains:

  • put out into surgical wounds at the end of the surgery

Aim: to allow an excess of pus or blood to be drained out of the body -> their accumulation and abscess formation is prevented

28
Q

Examples of the closed-suction drain?

How do we need to position them?

A
  • urinary catheter
  • chest drain
  • T - Tube connected to bile drain

Position: the bottle is kept below the patient -> fluid drains into gravity

29
Q

When do we remove the drain?

A

When it is draining <25 ml per day

*patients may be allowed home with the drain attached to them -> community nurse can remove them

30
Q

Two ways to assess if the drain is blocked

A

A. Swing test: drain is held and moved (swinged) from side to side -> the fluid line in the tube should move (if not blocked)

B. The patient coughs -> increased pressure -> fluid level in the drain should shift (performed for abdominal drains)

Surgery (18 decks)

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