Wound Care

Question 1

Process of Wound Healing

Answer 1

1. Inflammatory (3d)- Coagulation, tissue breakdown
2. Proliferative (3d-3w)- Deposition of Granulation Tissue, Type III Collagen, wound contraction
3. Remodeling (3w-6+m)- Type III to Type I collagen

Question 2

2 Types of wounds

Answer 2

1. Acute- Normal physiology, should heal completely

2. Chronic- impaired individuals, delayed healing

Question 3

3 considerations when addressing a wound

Answer 3

1. Timing of closure
2. Type of closure
3. Need for Consult

Question 4

Goals of acute wound care

Answer 4

1. Avoid infection
2. Assist in hemostasis
3. Esthetically pleasing scar

Question 5

What PE exam should be done for every wound?

Answer 5

Neurovascular distal to the injury

Question 6

3 options for wound closure

Answer 6

1. Primary- Wound closed in inflammatory phase (right there)
2. Delayed Primary- If wound has increased risk of infection, irrigate and schedule later repair
3. Secondary Intent- Wound allowed to heal inside to out if it is grossly contaminated and needs to be irrigated regularly

Question 7

Should you clean the open wound itself with a selected wound cleanser?

Answer 7

No, because wound cleanser is also cytotoxic to native cells

Question 8

Should you soak wounds in water or other solutions?

Answer 8

No! it doesn’t do anything and may increase risk of infection.
DO irrigate the hell out of it though

Question 9

A patient has a laceration on his penis because his girlfriend didn’t cut her nails. You decide to use lidocaine as your local. What is contraindicated to also give him?

Answer 9

Epinephrine because the penis is end-arterial supplied.

“Fingers, nose, penis, toes and ears!”

Question 10

What type of wounds can steri strips be used for?

Answer 10

Low Tension
Superficial
Linear

Question 11

What type of wounds can adhesives be used for?

Answer 11

Similar to steri strips 
Low tension
Superficial
<4cm 
*do not apply antibiotic ointment it breaks it down

Question 12

When can staples be used?

Answer 12

Scalp Lacerations

Areas where cosmesis isn’t a problem

Question 13

Which is a thicker suture, 1-0 or 5-0?

Answer 13

1-0. Same system as needles, higher the number the thinner the suture

Question 14

What suture size should be used on the face and how long should they stay in place?

Answer 14

At least 5-0 and at least 5 days. longer the suture stays in the more it can scar

Question 15

Where can you use the thickest sutures and leave them in the longest?

Answer 15

Trunk/Extremities

Question 16

After 24h, can you remove a dressing and let a wound open to air?

Answer 16

Yes generally this is ok

Question 17

When do you prescribe prophylactic Abx for a wound?

Answer 17

Bites
Oral Lacs
Excessive contamination 
Vascular Insufficiency 
Immunocompromised

Question 18

Common Chronic Wounds

Answer 18

Decubitus Ulcer
Diabetic Foot ulcer
Venous Ulcer
Traumatic wounds

Question 19

Where are pressure ulcers common?

Answer 19

anywhere there is a bony prominence (sacrum, coccyx, calcaneus are common)

Question 20

Describe the stages of Decubitus Ulcers

Answer 20

S1- intact, erythematous skin
S2- Partial-thickness skin lesion
S3- full thickness lesion with visible fat
S4- Full thickness with exposed fascia, muscle, tendon, ligament, or bone

Question 21

Treatment for Diabetic foot ulcers

Answer 21

Broad spectrum Abx
Prolong Abx use due to osteomyelitis risk
Wound vac if necessary

Question 22

Dry vs. Wet Gangrene

Answer 22

Dry- loss of blood supply to the area

Wet- bacterial infection

Question 23

Should you treat all ulcers with Abx?

Answer 23

No, only if there is evidence of infection