Wound closure and healing Flashcards
Wounds are designated as what 2 things?
- intentional or
2. unintentional
What can unintentional wounds be?
- incidental
- traumatic
- chronic
What is the classification of an intentional wound type?
surgical
What is an example of an intentional wound type?
an incision made into intact tissue
What are classifications of a traumatic wound type?
- open or closed
- simple or complicated
- clean or contaminated
What do traumatic intentional wounds include?
both life-threatening and less serious injuries
What is an example of an incidental intentional wound?
pressure-related injury caused by compromised circulation as a direct result of inadequate or inappropriate surgical positioning
What is an example of a chronic intentional wound?
chronic pressure injury as a result of tissue loss from arterial insufficiency or venous stasis
What does suture mean?
to stitch together
what does ligate mean?
to tie off a blood vessel to prevent or stop bleeding
What is ligation also used for?
to tie off the base of a tissue mass
What are the material classifications for suture?
- natural or synthetic
- absorbable or non-absorbable
- single strand (monofilament) or several strands (multifilament)
What do non-absorbable sutures resist?
enzymatic activity
How does the body protect a non-absorbable suture?
the body’s inflammatory response to a foreign body walls off the suture, protecting it from being broken down
What is a class 1 non-absorbable suture?
- silk or synthetic
2. monofilament
What does a class 1 non-absorbable suture look like?
twisted or braided
What is a class 2 non-absorbable suture?
- natural or synthetic fibers
2. monofilament or multifilament
What does a class 2 non-absorbable suture look like?
twisted or braided
What can a class 2 non-absorbable suture be?
coated
What does coating do for class 2 non-absorbable sutures?
- reduces friction when passing through tissues
2. coating affects thickness but not tensile strength of suture
What is a class 3 non-absorbable suture?
monofilament or multifilament metal wire
What are the uses for non-absorbable suture?
provides long-term tissue support
What are examples of places non-absorbable suture would be used?
- fascia
- tendons
- abdominal wall
How are absorbable sutures assimilated into the body?
by tissues through the health process through…
- digestion via enzyme activity OR
- hydrolysis from a chemical reaction with tissue fluids
What are absorption times for absorbable sutures?
depends, vary with the suture
What do absorbable sutures look like?
monofilament or braided
What are the 2 possible compositions of absorbable sutures?
- surgical gut
2. synthetic
what is surgical gut absorbable suture?
made from collagen derived from healthy mammals
What are the 2 uses of absorbable sutures?
- deep tissues
2. tissues that heal rapidly
What are 4 examples of absorbable suture uses?
- bowel anastomosis
- urinary tract
- biliary tracts
- small vessel ligation
What are 2 types of configuration?
- monofilament
2. multifilament
What is a monofilament configuration?
single-stranded
What is a multifilament suture configuration?
composed of several strands of suture material that are manufactured into a single strand by being braided or twisted
define capillarity
the capability of fluid that is absorbed by the suture to be transferred along the length of the suture
Explain suture size?
the suture size decreases as the zeros expressing the size increase (3-0 is smaller than 2-0)
what is the measurement of the suture’s ability to recover its primary form and length after stretching or other deformation?
elasticity
what is the measure of the suture strand’s capability to be stretched, tied, or otherwise misshapen from its original form without breaking?
plasticity
What is the inherent capability of the suture to keep or return to its original packaging shape after being stretched or tied?
memory
What do handling characteristics describe?
a suture’s bending ability and how easily a suture can move through tissue and be tied down
What are the 4 handling characteristics?
- pliability
- tissue drag
- knot tying
- knot slippage
define pliability
how easily the suture bends
what does tissue drag address?
how easily the suture slips through the tissue
define knot tying
how easily can a particular suture be tied
define knot slippage
the ability of the knots to be slid down the suture
What are the 4 types of tissue reactions?
- inflammation
- absorption
- infection potential
- allergic reaction
What is the a. characteristics b. tensile strength c. handling knot security d. absorption rate of cat gut?
a. absorbable monofilament
b. poor
c. good handling. poor knot security.
d. rapid variable rate within 2-14 days
What is the a. characteristics b. tensile strength c. handling knot security d. absorption rate of monocryl/caprosyn?
a. absorbable monofilament
b. high
c. excellent
d. rapid within 14 days
What is the a. characteristics b. tensile strength c. handling knot security d. absorption rate of vicryl/polysorb/dexon?
a. absorbable braided
b. moderate
c. excellent handling. moderate knot security
d. medium. about 3-4 weeks
What is the a. characteristics b. tensile strength c. handling knot security d. absorption rate of PDS/biosyn/maxon?
a. absorbable monofilament
b. high
c. poor overall
d. slow. at least 6 weeks
What is the a. characteristics b. tensile strength c. handling knot security d. absorption rate of nylon/prolene?
a. non-aborbable monofilament
b. high
c. poor
d. NA
Identify each component of this phrase: “I’ll take a 5-0 prolene on a p-3.”
- 5-0: suture size
- Prolene: suture type
- P-3: Needle
What are the 3 parts of a surgical needle?
- swage
- body
- point
describe swage
suture embedded into the end of a needle
describe body
round, rectangular, or flat
describe point
cutting, tapered, or blunt
What are the 2 types of threaded needles?
- eyed
2. spring or French-eyed
What is the disadvantage of a threaded needle?
they have two suture strands rather than 1
what are interrupted stitch types?
single sutures, tied independently
what is an uninterrupted suture type?
continuous or running
what is a retention suture type?
heavy suture reinforcing the primary suture line
what is a subcuticular suture type?
suture under the epidermis
what is a purse-string suture type?
suture around a circular wound
What are the 4 other skin closure options?
- skin staples
- skin adhesives
- adhesive tape strips
- zipper closures
what is a terminal-end stapler used for?
used to close the end of the colon after the side-to-end anastomosis of the sigmoid and rectum has been completed
what is an end-to-end stapler used for?
used in a multi-step procedure with the end-result of achieving an internal anastomosis of hollow organ space
what is an internal anastomosis stapler used for?
used for side-to-bowel anastomosis
What are the advantages of staples?
o Easy to use
o Provides uniform incisional tension
o Faster wound closure
what is the 1 disadvantage of staples?
Require extraction, unless staples are absorbable
What are the advantages of adhesives?
- reduced risk of infection
- less scarring
- eliminates skin closure device removal
What are the 3 disadvantages of adhesives?
- limited to use of superficial wounds
- higher allergic reaction rate
- not optimal for slow healing health conditions
What are the advantage of wound closure/adhesive strips?
- less expensive than other skin closure methods
What is the disadvantage of wound closure/adhesive strips
can lessen with moisture, causing wound compromise
What are the advantages of zippers?
o Skin stretching forces are distributed over a wide surface area , away from the wound edges
oMay replace the need for a tissue expander
o Faster application than suturing
o May provide a more cosmetic outcome
What are the disadvantages of zippers?
- cost
2. may not be an optimal option in the obese population
What is a first intention/primary union wound healing type?
clean, approximated incision is closed with suture or other appropriate product
What is a second intention wound healing type?
wound heals by granulation, leading to wound contracture
What is a third intention/delayed primary closure?
- delayed wound closure d/t considerable tissue loss and/or gross infection
- wound is not devascularized
- deep sutures are not used to avoid granuloma formation
What are the 4 surgical wound classes?
- class 1 - clean
- class 2: clean-contaminated
- class 3: contaminated
- class 4: dirty infected
What is an example of a class 1 wound?
total knee arthroplasty
What is an example of a class 2 surgical wound?
total hysterectomy; rasp-alimentary-or GI tract is entered
What is an example of a class 3 surgical wound?
gun shot wound
What is an example of a class 4 surgical wound?
incision and drainage of infected wound
What is the
a. location
b. timing
of a superficial incisional wound?
a. location: epidermis, dermis and SQ layers
b. timing: within 30 days after the surgery
What is the
a. location
b. timing
of a deep incisional wound?
a. location: fascial and muscle layers
b. between 30 and 90 days after the surgery
What is the
a. location
b. timing
of a organ space wound?
a. location: organ/space layer
b. timing: between 30 and 90 days after the surgery
what is the removal of dead tissue from a wound?
debridement
What is negative-pressure wound therapy?
a wound therapy employed for difficult wounds that have not responded to other care methods
What does negative-pressure wound therapy involve?
applies constant, controlled, negative pressure to a wound into which a drainage sponge has been placed
What are the 3 components of negative-pressure wound therapy?
- mechanical tension on tissues
- macro deformation
- micro deformation
What does mechanical tension on tissues cause?
fluid removal that reduces edema and decreases bacterial load
What does macro deformation do?
wound contracture
what does micro deformation do?
microscopic interaction between the wound tissue and the dressing
what are drains used for?
to provide an exit for blood, serum, bile, air, intestinal secretions, and pus
What do drains create?
a portal of entry for pathogenic microorganisms
What is required when emptying closed systems and changing a wound drain dressing?
aseptic technique
What is an example of a simple drain?
Penrose drain
What are examples of closed suction?
- hemovac
2. Jackson-pratt
Coefficient of friction is an element of which suture material characteristic?
handling (tissue drag, knot typing, and knot slippage)
what is a temporary wound treatment that can produce growth factors and stimulate wound healing?
skin substitute
