Wound Care Flashcards
What are langer’s lines?
correspond to natural orientation of collagen fibers in the dermis
What are langer’s lines parallel with?
underlying muscle fibers
Why do we have langer lines?
Important for improved cosmetic outcomes
What are the 4 phases of wound healing?
Hemostasis
Inflammation
Proliferation
Remodeling
Hemostasis
- immediately after wounding
- platelet plug forms and blood vessels vasoconstrict
- thrombus develops later to deal the wound
Inflammation
- Occurs in the first 2-3 days after injury
- WBC remove necrotic tissue and control infection
Which phase of wound healing is most pain present?
Inflammatory phase
Proliferation
- 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)
Remodeling
- 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
When is the strength of the wound strongest? By how much and how long?
Remodeling; 80% of original; up to a year
What must we always do before repair?
Confirm neurovascular and sensori-motor condition
6 Types of lacerations
Linear Stellate (burst) Corner Puncture Penetrating Gunshot
When do you give tetanus shots?
- update tetanus is over 10 years since last vaccine
- If wound is tetanus prone and last vaccine was over 5 years ago
Tetanus prone wounds
- wounds over 6 hours
- greater than 1cm deep
- stellate lacerations
- soiled with feces, saliva, gunshot, puncture, burn, frostbite
Dtap
- age 6weeks to 6 years
- 3-5x more diptheria component versus teh adult
- tetanus amount asme as adult
When do you only give the DT portion of DTap?
child can’t have pertussis vaccine
Tdap
give to 11 and older
When to clean wound with saline?
high pressure irrigation
When to clean wound with iodine?
- anti-septic
- best for cleaning skin around wound because it damages cells
When to clean wound with Hibiclens?
- anti-deptic
- good for cleaning wounds
When to clean wound with peroxide?
- anti-septic
best for removing blood from clothing, not good to clean wounds
When to clean wound with alcohol?
- anti-septic
- good for intact skin cleaning
Why do we use anesthesia when cleaning a wound?
to allow for successful exploration and closure of a wound/laceration
When do we use LET?
pediatrics
face or scalp; not effective on extremities
most commonly used
Topical LET and dosing
4% lidocaine, 1:2000 epinephrine, 0.5% tetracaine
Where do we not use LET?
where we don’t use epi
Onset of LET
20-30min
Local is most effective when?
directly applied to laceration or digital
Max dose of lidocaine
4mg/kg
How much fluid will a finger take
no more than 5cc
1% lidocaine does what
blocks pain stimuli, leaves pressure and touch intact
2% lidocaine blocks what
blocks awareness of stimuli including pressure and touch
Where do we avoid epinephrine
digits, nose, ear, penis
2 drugs for local anesthesia
Lidocaine and Epinephrine
When picking a suture, what does a bigger number mean?
the smaller the size of the suture
Size range for sutures
00 to 10-0
What are the most commonly used sizes of suture
3-0 to 6-0
What factors affect suture choice
Tensile strength Workability Knot security Low tissue reactivity Ability to resist bacterial infections
When to use absorbable sutures
under the skin, where they are well hidden
Which suture leaves a more pronounced scar?
absorbable
Why does the non-absorbable not leave a dramatic scar?
less tissue reactive
When do we use non-absorbable sutures
on the skin and in the OR
MC non-absorbable sutures
Ethilon (nylon), Prolene (polypropylene)
Absorbable suture used
Vicryl
Primary closure
- wound edges are neatly approximated
- rapid return to function
- good cosmetic outcome
- best utilized in 6-12hrs
Delayed Primary Closure
- used in situations where early primary closure is inappropriate (infected)
- allows for secondary healing before the wound is closed
- close after 48-96hrs
When to remove sutures of the eye
3 days
When to remove sutures of the cheek
3-5 days
When to remove sutures of the nose, forehead, neck?
5 days
When to remove sutures of the ear, scalp?
5-7 days
When to remove sutures of the arm, leg, hand, foot
7-10days+
When to remove sutures of the chest, back, abdomen
7-10days+
When to use staples
scalp; don’t use in cosmetic areas
