Wound Care

Question 1

What are langer’s lines?

Answer 1

correspond to natural orientation of collagen fibers in the dermis

Question 2

What are langer’s lines parallel with?

Answer 2

underlying muscle fibers

Question 3

Why do we have langer lines?

Answer 3

Important for improved cosmetic outcomes

Question 4

What are the 4 phases of wound healing?

Answer 4

Hemostasis
Inflammation
Proliferation
Remodeling

Question 5

Hemostasis

Answer 5

• immediately after wounding
• platelet plug forms and blood vessels vasoconstrict
• thrombus develops later to deal the wound

Question 6

Inflammation

Answer 6

• Occurs in the first 2-3 days after injury

- WBC remove necrotic tissue and control infection

Question 7

Which phase of wound healing is most pain present?

Answer 7

Inflammatory phase

Question 8

Proliferation

Answer 8

• Begins 2-3 days after injury
• lasts 2-4 weeks
• fibroblasts proliferate into the wound and produce structural proteins (glycosaminoglycans, collagen, elastin)
• New capillaries form and epithelial cells migrate across the top of the wound (granulation tissue)

Question 9

Remodeling

Answer 9

• New capilaries atrophy and collagen changes from type 3 to type 1 and is rearranged for best tensile strength
• Myofibroblast cause scar contracture
• Forces acting on the wound shape the remodeling process and the best result is obtained when the force is uniaxial

Question 10

When is the strength of the wound strongest? By how much and how long?

Answer 10

Remodeling; 80% of original; up to a year

Question 11

What must we always do before repair?

Answer 11

Confirm neurovascular and sensori-motor condition

Question 12

6 Types of lacerations

Answer 12

Linear
Stellate (burst)
Corner
Puncture
Penetrating
Gunshot

Question 13

When do you give tetanus shots?

Answer 13

• update tetanus is over 10 years since last vaccine

- If wound is tetanus prone and last vaccine was over 5 years ago

Question 14

Tetanus prone wounds

Answer 14

• wounds over 6 hours
• greater than 1cm deep
• stellate lacerations
• soiled with feces, saliva, gunshot, puncture, burn, frostbite

Question 15

Dtap

Answer 15

• age 6weeks to 6 years
• 3-5x more diptheria component versus teh adult
• tetanus amount asme as adult

Question 16

When do you only give the DT portion of DTap?

Answer 16

child can’t have pertussis vaccine

Question 17

Tdap

Answer 17

give to 11 and older

Question 18

When to clean wound with saline?

Answer 18

high pressure irrigation

Question 19

When to clean wound with iodine?

Answer 19

• anti-septic

- best for cleaning skin around wound because it damages cells

Question 20

When to clean wound with Hibiclens?

Answer 20

• anti-deptic

- good for cleaning wounds

Question 21

When to clean wound with peroxide?

Answer 21

• anti-septic

best for removing blood from clothing, not good to clean wounds

Question 22

When to clean wound with alcohol?

Answer 22

• anti-septic

- good for intact skin cleaning

Question 23

Why do we use anesthesia when cleaning a wound?

Answer 23

to allow for successful exploration and closure of a wound/laceration

Question 24

When do we use LET?

Answer 24

pediatrics
face or scalp; not effective on extremities
most commonly used

Question 25

Topical LET and dosing

Answer 25

4% lidocaine, 1:2000 epinephrine, 0.5% tetracaine

Question 26

Where do we not use LET?

Answer 26

where we don't use epi

Question 27

Onset of LET

Answer 27

20-30min

Question 28

Local is most effective when?

Answer 28

directly applied to laceration or digital

Question 29

Max dose of lidocaine

Answer 29

4mg/kg

Question 30

How much fluid will a finger take

Answer 30

no more than 5cc

Question 31

1% lidocaine does what

Answer 31

blocks pain stimuli, leaves pressure and touch intact

Question 32

2% lidocaine blocks what

Answer 32

blocks awareness of stimuli including pressure and touch

Question 33

Where do we avoid epinephrine

Answer 33

digits, nose, ear, penis

Question 34

2 drugs for local anesthesia

Answer 34

Lidocaine and Epinephrine

Question 35

When picking a suture, what does a bigger number mean?

Answer 35

the smaller the size of the suture

Question 36

Size range for sutures

Answer 36

00 to 10-0

Question 37

What are the most commonly used sizes of suture

Answer 37

3-0 to 6-0

Question 38

What factors affect suture choice

Answer 38

``` Tensile strength Workability Knot security Low tissue reactivity Ability to resist bacterial infections ```

Question 39

When to use absorbable sutures

Answer 39

under the skin, where they are well hidden

Question 40

Which suture leaves a more pronounced scar?

Answer 40

absorbable

Question 41

Why does the non-absorbable not leave a dramatic scar?

Answer 41

less tissue reactive

Question 42

When do we use non-absorbable sutures

Answer 42

on the skin and in the OR

Question 43

MC non-absorbable sutures

Answer 43

Ethilon (nylon), Prolene (polypropylene)

Question 44

Absorbable suture used

Answer 44

Vicryl

Question 45

Primary closure

Answer 45

- wound edges are neatly approximated - rapid return to function - good cosmetic outcome - best utilized in 6-12hrs

Question 46

Delayed Primary Closure

Answer 46

- used in situations where early primary closure is inappropriate (infected) - allows for secondary healing before the wound is closed - close after 48-96hrs

Question 47

When to remove sutures of the eye

Answer 47

3 days

Question 48

When to remove sutures of the cheek

Answer 48

3-5 days

Question 49

When to remove sutures of the nose, forehead, neck?

Answer 49

5 days

Question 50

When to remove sutures of the ear, scalp?

Answer 50

5-7 days

Question 51

When to remove sutures of the arm, leg, hand, foot

Answer 51

7-10days+

Question 52

When to remove sutures of the chest, back, abdomen

Answer 52

7-10days+

Question 53

When to use staples

Answer 53

scalp; don't use in cosmetic areas