Wound Care

Question 1

Do wounds heal best in a moist or dry environment?

Answer 1

Moist

Question 2

can you use tap water to clean wounds?

Answer 2

yes - ideally use sterile saline but not possible for large wounds

Question 3

what are some of the lesser-known risk factors for poor wound healing?

Answer 3

prior radiation therapy

spinal cord disease (immobilization)

edema

malnutrition

Question 4

What are the stages of wound healing?

Answer 4

1. hemostatis (immediate)
2. inflammation (0-4 days)
3. epithelization (5-21 days)
4. fibroplasia
5. maturation (22-60)

Question 5

each epithelial bud of epidermis arises from a __________?

Answer 5

single hair follicle

Question 6

what is a marker that repigmentation has occurred?

Answer 6

pigmentation of the wound consistent with the person’s skin color (easy to see dark better)

Question 7

What are the three types of wound healing?

Answer 7

primary

delayed primary

secondary

Question 8

what does primary wound healing mean?

Answer 8

closing wound immediately

“healing by first intention”

Question 9

what is delayed primary wound healing?

Answer 9

used for “dirty wounds” - wound is irrigated, packed, debrided and closed later

Question 10

what is secondary wound healing?

Answer 10

wound healing slowly by contracting from edges to close and often involves formation of scar tissue or skin grafts

Question 11

what is the difference between a hypertrophic scar and a keloid?

Answer 11

a hypertropic scar developes within the boundaries of the wound, while a keloid goes outside of it

also, keloids have a genetic component to them

Question 12

what are some treatments for hypertropic scarring?

Answer 12

compression garments

steriod injections

silicone gel sheeting

Question 13

what percentage of surgeries go on to develop a SSI?

Answer 13

2-5% (in the US)

Question 14

what is the most common SSI pathogen?

Answer 14

Staph aureus

Question 15

what are some less obvious ways to prevent SSIs?

Answer 15

nasal bactroban (MRSA)

warming techniques during surgery (hot dogs)

glycemic control

hair removal

chlorhexidine baths

gown/glove changing

Question 16

what is the risk of SSI based upon wound classification?

Answer 16

• clean <2% risk
• clean-contaminated <10% risk
• contaminated approximately 20% risk
• dirty 40% risk

Question 17

Listing of SSI pathogens and treatments

Answer 17

Question 18

what are the major forms of debridement?

Answer 18

surgical - currettes, scissors, Versajet

mechanical - wet-dry dressings

chemical - enzymatic debriders (Santyl)

Question 19

what is wet to dry dressing

Answer 19

gauze dressing that is applied damp (with saline or Dakins) and ripped off dry

Question 20

what is a hydrocolloid dressing?

Answer 20

a barrier dressing that can be used on wounds that are dry or minimally exudative - it is for protection of the skin and forms a moist layer to promote healing

ex. Duoderm (decubitus ulcers)

Question 21

what is a foam dressing?

Answer 21

it is used for moderate to heavy draining wounds form a barrier, but allow moisture to promote healing

Question 22

anastamoses of which GI wounds are most likely to leak?

Answer 22

colon

esophagus

Question 23

what are impregnated gauzes good for?

Answer 23

keeps wounds moist

not really good for antibiosis

(ex. Xeroform - petroleum impregnated +/- bacitracin or mupirocin)

Question 24

what is silvadene used for?

Answer 24

it is a silver-based antibiotic cream that is often used on 2nd degree burns

Question 25

what are wound vacs NOT good for?

Answer 25

infected wounds or wounds with necrotic tissue

Question 26

what are the dressing options for infected wounds?

Answer 26

wet-to-dry

Dakin’s solution

antibiotic impregnated solutions (sulfamulon

tobra/gentamycin soln)

Question 27

what’s the treatment for a decuibitus ulcer?

Answer 27

relieve pressure

protecte surrounding skin

aggressive wound care

Question 28

what must you be careful about when using bacitracin?

Answer 28

10% of the population has a dermatologic sensitivity to it

Question 29

What are the stages of decubitus ulcers?

Answer 29

Stage I - non-blanchable erythema. Skin is intact, no blistering. Maybe be painful, warm, or cooler than surrounding tissue.

Stage II - partial thinkness. partial thickness loss of dermis. can present as early boggy, serum or blood filled blister. shallow tissue ulceration with pink/red tissue - NO slough or eschar

Stage III - full thickness skin loss. subcutaneous fat or slough may be present, but without bone or tendon exposure, or directly palpable

Stage IV - full thickness tissue loss with tendon loss or bone exposure

Question 30

How do you stage a decubitus ulcer when you cannot see to the bottom?

Answer 30

you don’t

Question 31

If a decubitus ulcer does not improve over time, what should you rule out?

Answer 31

rule out infection

rule out cancer

rule out arterial or venous insufficiency

ensure adequate debridement

Question 32

wht other therapies might you consider for non-healing wounds

Answer 32

negative pressure wound therapy (wound vac)

hyperbaric therapy

skin graft vs. flap

Question 33

preoperative nutrition is recommended prior to surgical correction for patients who have lost ___% or more of their body weight?

Answer 33

10

Question 34

when is a wound contaminated vs. colonized?

Answer 34

the presence of more than 10⁵ bacteria/gram is considered contaminated (infected)?