Wound Care Flashcards
Process of Wound Healing
- Inflammatory (3d)- Coagulation, tissue breakdown
- Proliferative (3d-3w)- Deposition of Granulation Tissue, Type III Collagen, wound contraction
- Remodeling (3w-6+m)- Type III to Type I collagen
2 Types of wounds
- Acute- Normal physiology, should heal completely
2. Chronic- impaired individuals, delayed healing
3 considerations when addressing a wound
- Timing of closure
- Type of closure
- Need for Consult
Goals of acute wound care
- Avoid infection
- Assist in hemostasis
- Esthetically pleasing scar
What PE exam should be done for every wound?
Neurovascular distal to the injury
3 options for wound closure
- Primary- Wound closed in inflammatory phase (right there)
- Delayed Primary- If wound has increased risk of infection, irrigate and schedule later repair
- Secondary Intent- Wound allowed to heal inside to out if it is grossly contaminated and needs to be irrigated regularly
Should you clean the open wound itself with a selected wound cleanser?
No, because wound cleanser is also cytotoxic to native cells
Should you soak wounds in water or other solutions?
No! it doesn’t do anything and may increase risk of infection.
DO irrigate the hell out of it though
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?
Epinephrine because the penis is end-arterial supplied.
“Fingers, nose, penis, toes and ears!”
What type of wounds can steri strips be used for?
Low Tension
Superficial
Linear
What type of wounds can adhesives be used for?
Similar to steri strips Low tension Superficial <4cm *do not apply antibiotic ointment it breaks it down
When can staples be used?
Scalp Lacerations
Areas where cosmesis isn’t a problem
Which is a thicker suture, 1-0 or 5-0?
1-0. Same system as needles, higher the number the thinner the suture
What suture size should be used on the face and how long should they stay in place?
At least 5-0 and at least 5 days. longer the suture stays in the more it can scar
Where can you use the thickest sutures and leave them in the longest?
Trunk/Extremities
After 24h, can you remove a dressing and let a wound open to air?
Yes generally this is ok
When do you prescribe prophylactic Abx for a wound?
Bites Oral Lacs Excessive contamination Vascular Insufficiency Immunocompromised
Common Chronic Wounds
Decubitus Ulcer
Diabetic Foot ulcer
Venous Ulcer
Traumatic wounds
Where are pressure ulcers common?
anywhere there is a bony prominence (sacrum, coccyx, calcaneus are common)
Describe the stages of Decubitus Ulcers
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
Treatment for Diabetic foot ulcers
Broad spectrum Abx
Prolong Abx use due to osteomyelitis risk
Wound vac if necessary
Dry vs. Wet Gangrene
Dry- loss of blood supply to the area
Wet- bacterial infection
Should you treat all ulcers with Abx?
No, only if there is evidence of infection
