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Surgery Oral Boards Prep > Wound Closure/Dirty Wounds > Flashcards

Wound Closure/Dirty Wounds Flashcards

1
Q

closed by direct approximation of the wound edges is […] healing

A

primary

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2
Q

wound is left open and allowed to heal spontaneously from the edges is […] healing

A

secondary

close via contraction and epithelialization

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3
Q

wound is closed by active means after a delay of weeks or months is […] healing

A

tertiary

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4
Q

how long do sutures stay in trunks/extremities?

A

7-10 days

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5
Q

how long do sutures stay in face/neck?

A

4 days

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6
Q

[…] and […] are used on skin because they are less reactive

A

prolene
nylon

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7
Q

[…] needles for fascia/bowel
[…] needles for skin

A

tapered
cutting

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8
Q

what size suture for deep tissue?

A

2-0 to 4-0

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9
Q

what size suture for torso/extremities?

A

3-0 to 4-0

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10
Q

what size suture for face/neck?

A

5-0 to 6-0

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11
Q

cardinal signs of inflammation

A

rubor
dolor
calor
tumor

loss of function

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12
Q

what kind of suture would you use for subcuticular skin closure?

A

monocryl

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13
Q

3 types of absorbable sutures

A

chromic
vicryl
monocryl

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14
Q

3 types of non-absorbent sutures

A

nylon
polyester
prolene

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15
Q

for closure of muscle, […] provides the greatest strength

for closure of skin, […] provides the greatest strength

A

fascia
dermis

(deep sutures should be absorbable and placed in layer of greatest strength)

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16
Q

do you close peritoneum?

A

no –increases likelihood of adhesions

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17
Q

fascial closure should be done with […] or […]

A

PDS
prolene

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18
Q

putting interrupted sutures in the fat decreases [….]

A

dead space

(no tension here)

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19
Q

HIS FRIENDS mnemonic for factors that impair healing fistula

A

High output (>500 cc/24 hrs)
Injury
Size (less than 2 cm)
Foreign body
Radiation
Infection
Epithelialization
Neoplasm
Distal obstruction
Steroids

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20
Q

risk factors for infection

A

foreign body
decreased blood flow
necrosis
long operation time
strangulation
hypothermia
hematomas
seromas
dead space
poorly approximated tissue

21
Q

patient factors for poor wound healing

A

older
smoking
obesity
malnutrition
diabetes
uremia
malignancy
immunosuppresion
chemotherapy
trauma
burn
hypovolemic shock
PAD
infection

22
Q

what labs/imaging do you want if you suspect infection?

A

CBC
CMP
lactate
blood cultures, wound cultures
UA

CT or US to look for abscess

23
Q

what should you use to suture a facial laceration?

A

6-0 prolene on cutting needle
do interrupted sutures
out in 3-5 days to prevent hash marks

(use absorbable in peds)

24
Q

how long should you leave staples in scalp?

A

10-14 days

25
Q

what is chromic used for?

A

large gashes in mouth or vaginal tears

26
Q

what should you counsel the patient on if they have a hematoma under the incision?

A

may auto-express as it liquifies, don’t be alarmed

27
Q

what should you use to repair tendon?

A

4-0 prolene on tapered needle

28
Q

how long should sutures stay in back?

A

2+ weeks

(very thick dermis)

29
Q

how long should sutures stay in abdominal incision?

A

10-14 days

30
Q

how would you describe an atraumatic wound with no GI, GU or respiratory involvement?

A

clean

(3% infection rate)

31
Q

how would you describe a wound with minor sterile breaks or entrance to GI, GU or resp tract without significant contamination?

A

clean contaminated

8% infection rate

32
Q

how would you describe wound with entrance to GI, GU or resp tract with spillage of contents?

A

contaminated

15% infection rate

33
Q

how would you describe wound with soild and particulate matter?

A

contaminated

15% infection rate

34
Q

how would you describe wound with active infection like an abscess?

A

dirty

35% infection rate

35
Q

a wound is considered infected when the level of contamination is greater than

A

10 ^ 5 organisms per gram of tissue

36
Q

[…] is the most important technique to decrease bacterial load

A

debridement

37
Q

dressing changes should be limited to […] to prevent adversely affecting the progression of wound healing

A

twice daily

38
Q

what type of antibacterials can be used topically to penetrate granulation tissue?

A

silver sulfadiazine
mafenide acetate

(do NOT use near eyes)

39
Q

unknown or incomplete tetanus immunization

A

tetanus toxoid and immunoglobulin

40
Q

complete tetanus series, but last immunization more than 5 years ago

A

tetanus toxoid

41
Q

complete tetanus series last immunization less than 5 years ago

A

nothing

42
Q

granulation tissue consists of […] and […]

A

capillaries and fibroblasts

43
Q

do systemic abx penetrate granulation tissue?

A

no

44
Q

how should you stop bleeding when you find a wound?

A

manual pressure

(not tourniquet)

45
Q

after you debride a wound, how should you dress it?

A

pack open and change BID

46
Q

what should you expect if have an abdominal wound that is continuously leaking clear fluid?

A

dehiscence

(fasical layer not closed)

47
Q

how should you treat wound dehiscence?

A

compression or debridement/closure

depends on stability of the patient

48
Q

what is treatment of evisceration?

A

moist covering –> OR

49
Q

if you don’t repair a fascial dehiscence, what will the patient get?

A

incisional hernia

Surgery Oral Boards Prep (3 decks)

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