Wound Closure/Dirty Wounds Flashcards
closed by direct approximation of the wound edges is […] healing
primary
wound is left open and allowed to heal spontaneously from the edges is […] healing
secondary
close via contraction and epithelialization
wound is closed by active means after a delay of weeks or months is […] healing
tertiary
how long do sutures stay in trunks/extremities?
7-10 days
how long do sutures stay in face/neck?
4 days
[…] and […] are used on skin because they are less reactive
prolene
nylon
[…] needles for fascia/bowel
[…] needles for skin
tapered
cutting
what size suture for deep tissue?
2-0 to 4-0
what size suture for torso/extremities?
3-0 to 4-0
what size suture for face/neck?
5-0 to 6-0
cardinal signs of inflammation
rubor
dolor
calor
tumor
loss of function
what kind of suture would you use for subcuticular skin closure?
monocryl
3 types of absorbable sutures
chromic
vicryl
monocryl
3 types of non-absorbent sutures
nylon
polyester
prolene
for closure of muscle, […] provides the greatest strength
for closure of skin, […] provides the greatest strength
fascia
dermis
(deep sutures should be absorbable and placed in layer of greatest strength)
do you close peritoneum?
no –increases likelihood of adhesions
fascial closure should be done with […] or […]
PDS
prolene
putting interrupted sutures in the fat decreases [….]
dead space
(no tension here)
HIS FRIENDS mnemonic for factors that impair healing fistula
High output (>500 cc/24 hrs)
Injury
Size (less than 2 cm)
Foreign body
Radiation
Infection
Epithelialization
Neoplasm
Distal obstruction
Steroids
risk factors for infection
foreign body
decreased blood flow
necrosis
long operation time
strangulation
hypothermia
hematomas
seromas
dead space
poorly approximated tissue
patient factors for poor wound healing
older
smoking
obesity
malnutrition
diabetes
uremia
malignancy
immunosuppresion
chemotherapy
trauma
burn
hypovolemic shock
PAD
infection
what labs/imaging do you want if you suspect infection?
CBC
CMP
lactate
blood cultures, wound cultures
UA
CT or US to look for abscess
what should you use to suture a facial laceration?
6-0 prolene on cutting needle
do interrupted sutures
out in 3-5 days to prevent hash marks
(use absorbable in peds)
how long should you leave staples in scalp?
10-14 days
what is chromic used for?
large gashes in mouth or vaginal tears
what should you counsel the patient on if they have a hematoma under the incision?
may auto-express as it liquifies, don’t be alarmed
what should you use to repair tendon?
4-0 prolene on tapered needle
how long should sutures stay in back?
2+ weeks
(very thick dermis)
how long should sutures stay in abdominal incision?
10-14 days
how would you describe an atraumatic wound with no GI, GU or respiratory involvement?
clean
(3% infection rate)
how would you describe a wound with minor sterile breaks or entrance to GI, GU or resp tract without significant contamination?
clean contaminated
8% infection rate
how would you describe wound with entrance to GI, GU or resp tract with spillage of contents?
contaminated
15% infection rate
how would you describe wound with soild and particulate matter?
contaminated
15% infection rate
how would you describe wound with active infection like an abscess?
dirty
35% infection rate
a wound is considered infected when the level of contamination is greater than
10 ^ 5 organisms per gram of tissue
[…] is the most important technique to decrease bacterial load
debridement
dressing changes should be limited to […] to prevent adversely affecting the progression of wound healing
twice daily
what type of antibacterials can be used topically to penetrate granulation tissue?
silver sulfadiazine
mafenide acetate
(do NOT use near eyes)
unknown or incomplete tetanus immunization
tetanus toxoid and immunoglobulin
complete tetanus series, but last immunization more than 5 years ago
tetanus toxoid
complete tetanus series last immunization less than 5 years ago
nothing
granulation tissue consists of […] and […]
capillaries and fibroblasts
do systemic abx penetrate granulation tissue?
no
how should you stop bleeding when you find a wound?
manual pressure
(not tourniquet)
after you debride a wound, how should you dress it?
pack open and change BID
what should you expect if have an abdominal wound that is continuously leaking clear fluid?
dehiscence
(fasical layer not closed)
how should you treat wound dehiscence?
compression or debridement/closure
depends on stability of the patient
what is treatment of evisceration?
moist covering –> OR
if you don’t repair a fascial dehiscence, what will the patient get?
incisional hernia
