Wound care and suturing

Question 1

What environment is required for good wound healing?

Answer 1

Warm and moist

Question 2

Give three important principles of wound dressing

Answer 2

Aseptic, protect, absorbent

Question 3

Why is a moist environment good?

Answer 3

Encourages synthesis of collagen and ground substance
 Promotes revascularisation
 Decreases length of inflammatory phase
 Reduces pain and trauma due to dressing adherence
 Promotes breakdown of necrotic tissue
 Speeds wound contraction

Question 4

Two main reasons for swabbing in healthcare

Answer 4

Screening (MRSA) and suspected infection

Question 5

MRSA swabbing - sites

Answer 5

Both nostrils (1 swab) and both groins (1 swab)

Question 6

Give 4 screening criteria for MRSA

Answer 6

Patients with a previous history of MRSA
• Patients that have undergone surgical procedures within the last month
• Patients admitted from another hospital facility
• Patients admitted form a nursing/residential care home facility
• Intravenous drug user
• Patients who self-harm (breaking the skin within the last month)
• Patients with chronic wounds e.g. leg ulcers
• Patients with indwelling devices e.g. urinary catheters, PEG

Question 7

What two things in a wound/ulcer might indicate infection

Answer 7

Inflammation, slow healing

Question 8

Give 4 grades of pressure ulcer

Answer 8

Intact skin (non-blanching erythema)
Partial thickness (epidermis +/- dermis)
Full thickness (includes SC tissue)
Necrosis

Question 9

Wound dressing

a) If unsure what type to use, refer to…
b) If wound is complex, call the…
c) When applying dressing to lower leg, always apply bandage from ___ to ____.

Answer 9

a) Formulary
b) TVN
c) Toe to knee

Question 10

What are the four phases of wound healing?

Answer 10

Vascular, inflammatory, proliferative, maturation

Question 11

Vascular phase:

a) 2 processes
b) Rationale
c) Duration
d) Temporary closure through a _____ mesh

Answer 11

a) Vasoconstriction, clotting
b) Prevent blood loss
c) Minutes
d) Fibrin

Question 12

Inflammatory phase:

a) Vaso_____ occurs - mediated by….?
b) Duration
c) Cellular components and function
d) Defined by what 5 features
e) Dead cellular debris on wound surface can result in the development of ______. How can this be removed?

Answer 12

a) Vasodilation - mediated by histamine and other inflammatory mediators
b) ~ 1 week (peaks 20 mins post-injury)
c) Neutrophils (1st on scene, free radicals), Macrophages (phagocytosis, recruit lymphocytes), Lymphocytes (secrete cytokines to recruit fibroblasts)
d) Calor (heat), Rubor (red), Dolor (pain), Tumor (swelling) and Loss of function
e) slough; hydrogel

Question 13

Proliferative phase:

a) _______ secrete ______ to build new tissue
b) Duration
c) Give three physiological processes that occur

Answer 13

a) Fibroblasts; collagen
b) from 72hrs post-injury to ~ 1 month
c) Epithelialisation (formation of new epithelium), granulation (formation of new matrix), angiogenesis

Question 14

Leg ulcers:

a) Risk factors for (i) venous (ii) arterial (iii) neuropathic
b) Location for each
c) Other features of each
d) ABPI threshold for compression bandaging

Answer 14

a) i) varicose veins, DM, phlebitis, previous DVT ii) PVD, DM, CHD, previous stroke/TIA iii) DM, CMT
b) i) calf, medial malleolus, ii) distal, toes, dorsum of foot, iii) pressure points
c) i) lipodermatosclerosis, hyperpigmentation ii) hairless, pale, weak pulses, nocturnal pain, iii) no sensation, punched out
d) >0.8

Question 15

Maturation stage:

a) Duration
b) Strength of wound at i) week 1, ii) month 1, iii) month 3

Answer 15

a) From day 20(ish) for months/years depending on wound size
b) - 10% by end of the first week
- 70% by 4 weeks
- 80% by 3 months

Question 16

a) Primary intention - define, example and shape
b) Secondary intention - define and example
c) Tertiary intention - define and example

Answer 16

a) wound edges apposed; Surgical scar, with sutures/staples; linear;
b) wound edges not apposed, allowed to granulate; ulcer or burn
c) wound purposefully left open; initially cleaned and debrided, later surgically closed (e.g. by graft)

Question 17

Patient barriers to healing

Answer 17

Elderly
Diabetes – microvascular disease, neuropathy, raised glucose
Malnutrition
Malignancy – local or general
Renal or hepatic failure
Drugs
Immunosuppressive diseases
Vitamin deficiencies

Question 18

Local barriers to healing

Answer 18

Site
Infection
Oedema
Vascular insufficiency
Previous radiotherapy