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AORN Periop class > Wound closure and healing > Flashcards

Wound closure and healing Flashcards

1
Q

Wounds are designated as what 2 things?

A
  1. intentional or

2. unintentional

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2
Q

What can unintentional wounds be?

A
  1. incidental
  2. traumatic
  3. chronic
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3
Q

What is the classification of an intentional wound type?

A

surgical

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4
Q

What is an example of an intentional wound type?

A

an incision made into intact tissue

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5
Q

What are classifications of a traumatic wound type?

A
  1. open or closed
  2. simple or complicated
  3. clean or contaminated
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6
Q

What do traumatic intentional wounds include?

A

both life-threatening and less serious injuries

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7
Q

What is an example of an incidental intentional wound?

A

pressure-related injury caused by compromised circulation as a direct result of inadequate or inappropriate surgical positioning

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8
Q

What is an example of a chronic intentional wound?

A

chronic pressure injury as a result of tissue loss from arterial insufficiency or venous stasis

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9
Q

What does suture mean?

A

to stitch together

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10
Q

what does ligate mean?

A

to tie off a blood vessel to prevent or stop bleeding

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11
Q

What is ligation also used for?

A

to tie off the base of a tissue mass

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12
Q

What are the material classifications for suture?

A
  1. natural or synthetic
  2. absorbable or non-absorbable
  3. single strand (monofilament) or several strands (multifilament)
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13
Q

What do non-absorbable sutures resist?

A

enzymatic activity

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14
Q

How does the body protect a non-absorbable suture?

A

the body’s inflammatory response to a foreign body walls off the suture, protecting it from being broken down

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15
Q

What is a class 1 non-absorbable suture?

A
  1. silk or synthetic

2. monofilament

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16
Q

What does a class 1 non-absorbable suture look like?

A

twisted or braided

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17
Q

What is a class 2 non-absorbable suture?

A
  1. natural or synthetic fibers

2. monofilament or multifilament

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18
Q

What does a class 2 non-absorbable suture look like?

A

twisted or braided

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19
Q

What can a class 2 non-absorbable suture be?

A

coated

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20
Q

What does coating do for class 2 non-absorbable sutures?

A
  1. reduces friction when passing through tissues

2. coating affects thickness but not tensile strength of suture

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21
Q

What is a class 3 non-absorbable suture?

A

monofilament or multifilament metal wire

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22
Q

What are the uses for non-absorbable suture?

A

provides long-term tissue support

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23
Q

What are examples of places non-absorbable suture would be used?

A
  1. fascia
  2. tendons
  3. abdominal wall
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24
Q

How are absorbable sutures assimilated into the body?

A

by tissues through the health process through…

  1. digestion via enzyme activity OR
  2. hydrolysis from a chemical reaction with tissue fluids
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25
Q

What are absorption times for absorbable sutures?

A

depends, vary with the suture

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26
Q

What do absorbable sutures look like?

A

monofilament or braided

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27
Q

What are the 2 possible compositions of absorbable sutures?

A
  1. surgical gut

2. synthetic

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28
Q

what is surgical gut absorbable suture?

A

made from collagen derived from healthy mammals

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29
Q

What are the 2 uses of absorbable sutures?

A
  1. deep tissues

2. tissues that heal rapidly

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30
Q

What are 4 examples of absorbable suture uses?

A
  1. bowel anastomosis
  2. urinary tract
  3. biliary tracts
  4. small vessel ligation
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31
Q

What are 2 types of configuration?

A
  1. monofilament

2. multifilament

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32
Q

What is a monofilament configuration?

A

single-stranded

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33
Q

What is a multifilament suture configuration?

A

composed of several strands of suture material that are manufactured into a single strand by being braided or twisted

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34
Q

define capillarity

A

the capability of fluid that is absorbed by the suture to be transferred along the length of the suture

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35
Q

Explain suture size?

A

the suture size decreases as the zeros expressing the size increase (3-0 is smaller than 2-0)

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36
Q

what is the measurement of the suture’s ability to recover its primary form and length after stretching or other deformation?

A

elasticity

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37
Q

what is the measure of the suture strand’s capability to be stretched, tied, or otherwise misshapen from its original form without breaking?

A

plasticity

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38
Q

What is the inherent capability of the suture to keep or return to its original packaging shape after being stretched or tied?

A

memory

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39
Q

What do handling characteristics describe?

A

a suture’s bending ability and how easily a suture can move through tissue and be tied down

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40
Q

What are the 4 handling characteristics?

A
  1. pliability
  2. tissue drag
  3. knot tying
  4. knot slippage
41
Q

define pliability

A

how easily the suture bends

42
Q

what does tissue drag address?

A

how easily the suture slips through the tissue

43
Q

define knot tying

A

how easily can a particular suture be tied

44
Q

define knot slippage

A

the ability of the knots to be slid down the suture

45
Q

What are the 4 types of tissue reactions?

A
  1. inflammation
  2. absorption
  3. infection potential
  4. allergic reaction
46
Q 
What is the 
a. characteristics 
b. tensile strength 
c. handling knot security 
d. absorption rate 
of cat gut?
A

a. absorbable monofilament
b. poor
c. good handling. poor knot security.
d. rapid variable rate within 2-14 days

47
Q 
What is the 
a. characteristics 
b. tensile strength 
c. handling knot security 
d. absorption rate 
of monocryl/caprosyn?
A

a. absorbable monofilament
b. high
c. excellent
d. rapid within 14 days

48
Q 
What is the 
a. characteristics 
b. tensile strength 
c. handling knot security 
d. absorption rate 
of vicryl/polysorb/dexon?
A

a. absorbable braided
b. moderate
c. excellent handling. moderate knot security
d. medium. about 3-4 weeks

49
Q 
What is the 
a. characteristics 
b. tensile strength 
c. handling knot security 
d. absorption rate 
of PDS/biosyn/maxon?
A

a. absorbable monofilament
b. high
c. poor overall
d. slow. at least 6 weeks

50
Q 
What is the 
a. characteristics 
b. tensile strength 
c. handling knot security 
d. absorption rate 
of nylon/prolene?
A

a. non-aborbable monofilament
b. high
c. poor
d. NA

51
Q

Identify each component of this phrase: “I’ll take a 5-0 prolene on a p-3.”

A
  1. 5-0: suture size
  2. Prolene: suture type
  3. P-3: Needle
52
Q

What are the 3 parts of a surgical needle?

A
  1. swage
  2. body
  3. point
53
Q

describe swage

A

suture embedded into the end of a needle

54
Q

describe body

A

round, rectangular, or flat

55
Q

describe point

A

cutting, tapered, or blunt

56
Q

What are the 2 types of threaded needles?

A
  1. eyed

2. spring or French-eyed

57
Q

What is the disadvantage of a threaded needle?

A

they have two suture strands rather than 1

58
Q

what are interrupted stitch types?

A

single sutures, tied independently

59
Q

what is an uninterrupted suture type?

A

continuous or running

60
Q

what is a retention suture type?

A

heavy suture reinforcing the primary suture line

61
Q

what is a subcuticular suture type?

A

suture under the epidermis

62
Q

what is a purse-string suture type?

A

suture around a circular wound

63
Q

What are the 4 other skin closure options?

A
  1. skin staples
  2. skin adhesives
  3. adhesive tape strips
  4. zipper closures
64
Q

what is a terminal-end stapler used for?

A

used to close the end of the colon after the side-to-end anastomosis of the sigmoid and rectum has been completed

65
Q

what is an end-to-end stapler used for?

A

used in a multi-step procedure with the end-result of achieving an internal anastomosis of hollow organ space

66
Q

what is an internal anastomosis stapler used for?

A

used for side-to-bowel anastomosis

67
Q

What are the advantages of staples?

A

o Easy to use
o Provides uniform incisional tension
o Faster wound closure

68
Q

what is the 1 disadvantage of staples?

A

Require extraction, unless staples are absorbable

69
Q

What are the advantages of adhesives?

A
  1. reduced risk of infection
  2. less scarring
  3. eliminates skin closure device removal
70
Q

What are the 3 disadvantages of adhesives?

A
  1. limited to use of superficial wounds
  2. higher allergic reaction rate
  3. not optimal for slow healing health conditions
71
Q

What are the advantage of wound closure/adhesive strips?

A
  1. less expensive than other skin closure methods
72
Q

What is the disadvantage of wound closure/adhesive strips

A

can lessen with moisture, causing wound compromise

73
Q

What are the advantages of zippers?

A

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

74
Q

What are the disadvantages of zippers?

A
  1. cost

2. may not be an optimal option in the obese population

75
Q

What is a first intention/primary union wound healing type?

A

clean, approximated incision is closed with suture or other appropriate product

76
Q

What is a second intention wound healing type?

A

wound heals by granulation, leading to wound contracture

77
Q

What is a third intention/delayed primary closure?

A
  1. delayed wound closure d/t considerable tissue loss and/or gross infection
  2. wound is not devascularized
  3. deep sutures are not used to avoid granuloma formation
78
Q

What are the 4 surgical wound classes?

A
  1. class 1 - clean
  2. class 2: clean-contaminated
  3. class 3: contaminated
  4. class 4: dirty infected
79
Q

What is an example of a class 1 wound?

A

total knee arthroplasty

80
Q

What is an example of a class 2 surgical wound?

A

total hysterectomy; rasp-alimentary-or GI tract is entered

81
Q

What is an example of a class 3 surgical wound?

A

gun shot wound

82
Q

What is an example of a class 4 surgical wound?

A

incision and drainage of infected wound

83
Q

What is the
a. location
b. timing
of a superficial incisional wound?

A

a. location: epidermis, dermis and SQ layers

b. timing: within 30 days after the surgery

84
Q

What is the
a. location
b. timing
of a deep incisional wound?

A

a. location: fascial and muscle layers

b. between 30 and 90 days after the surgery

85
Q

What is the
a. location
b. timing
of a organ space wound?

A

a. location: organ/space layer

b. timing: between 30 and 90 days after the surgery

86
Q

what is the removal of dead tissue from a wound?

A

debridement

87
Q

What is negative-pressure wound therapy?

A

a wound therapy employed for difficult wounds that have not responded to other care methods

88
Q

What does negative-pressure wound therapy involve?

A

applies constant, controlled, negative pressure to a wound into which a drainage sponge has been placed

89
Q

What are the 3 components of negative-pressure wound therapy?

A
  1. mechanical tension on tissues
  2. macro deformation
  3. micro deformation
90
Q

What does mechanical tension on tissues cause?

A

fluid removal that reduces edema and decreases bacterial load

91
Q

What does macro deformation do?

A

wound contracture

92
Q

what does micro deformation do?

A

microscopic interaction between the wound tissue and the dressing

93
Q

what are drains used for?

A

to provide an exit for blood, serum, bile, air, intestinal secretions, and pus

94
Q

What do drains create?

A

a portal of entry for pathogenic microorganisms

95
Q

What is required when emptying closed systems and changing a wound drain dressing?

A

aseptic technique

96
Q

What is an example of a simple drain?

A

Penrose drain

97
Q

What are examples of closed suction?

A
  1. hemovac

2. Jackson-pratt

98
Q

Coefficient of friction is an element of which suture material characteristic?

A

handling (tissue drag, knot typing, and knot slippage)

99
Q

what is a temporary wound treatment that can produce growth factors and stimulate wound healing?

A

skin substitute

AORN Periop class (23 decks)

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