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Wound Healing > Wound Closures > Flashcards

Wound Closures Flashcards

1
Q

What are wounds designated as?

A

Intentional or unintentional

Same wound healing process for both

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2
Q

What is an intentional wound?

A

Surgical wounds

An incision made into intact tissue

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3
Q

What are unintentional wounds?

A

Traumatic
Incidental
Chronic

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4
Q

Traumatic wounds?

A

Life threatening or less serious

  • open or closed
  • simple or complicated
  • clean or contaminated
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5
Q

Incidental wounds?

A

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

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6
Q

Chronic wounds?

A

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

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7
Q

Suture vs ligate?

A

Suture - stitch together

Ligate - to tie off to prevent bleeding

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8
Q

Non absorbable sutures?

A

Resists enzyme activity

Not broken doen by inflammatory response

Provides mong term support
Ex. Abd wall

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9
Q

Composition of non absorbable sutures?

A

Synthetic, natural
Can be coated
Mono or multifilament

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10
Q

Non absorbable suture materials?

A

Natural:

  • Silk
  • Stainless steel

Synthetic:

  • Nylon
  • Polyester
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11
Q

What does coated sutures do?

A

Reduces friction when passing through tissues

Coating affects thickness but not tensile strength

Ex: antibacterial coating

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12
Q

Absorbable sutures?

A

Assimilated by tissues during healing process through digestion (enzymes) or hydrolysis from a chemical reaction with tissue fluids

Monofilament or braided

Examples: deep tissue, bowel anastomosis, vessel ligation

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13
Q

Composition of absorbable sutures?

A

Natural
- surgical gut: made drom collagen from animals
• plain or chromic

Synthetic
- made with polyglycolic acid and polyglactin

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14
Q

What can choosing wrong suture result in?

A

Tissue reaction
Dehiscence
Poor surgical outcomes

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15
Q

Suture material characteristics?

A

Physical configuration
Handling ability
Tissue reaction

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16
Q

Physical characteristics of a suture?

A 
Configuration 
Coating 
Capillarity 
Diameter 
Tensile strength
Knot strength 
Elasticity
Plasticity 
Memory 
Knot tensile strength
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17
Q

What is suture configuration?

A

Monofilament- single strand

Multifilament- several strands braided or twisted

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18
Q

What is suture capillarity?

A

Fluid absorbed by the suture that is transfered along length of the suture

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19
Q

Diameter: gauge of suture?

A

Size described by zeros
Suture size decreases as the number increases
Ex 4-0 small than 2-0
Small sutures are easily handled and tied but has less tensile strength

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20
Q

What is suture tensile strength?

A

Measurement of the suture strands ability to resist breakage

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21
Q

What is suture knot strength?

A

Force required to allow knot to slip on itself

Related to pliability and the co efficient of knot tying and knot slippage

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22
Q

Suture elasticity?

A

Measurement of sutures ability to recover its primary form and length after being stretching or other deformation

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23
Q

What is suture plasticity?

A

Measure of the suture strands capability to be stretched, tied or misshapen from original form without breaking

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24
Q

Suture memory?

A

Capability of suture to keep or return to its original packaging shape after being stretched or tied

High memory leads to lower confidence in knot security

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25
Q

Suture knot tensile strength?

A

Breaking point of a knotted suture

Sutures are 10-40% weaker after being tied

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26
Q

Examples of absorbable sutures?

A

Monocryl (used closed to skin)
Vicryl
PDS (deep)

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27
Q

Handling characteristics of a suture?

A

Pliability
Tissue drag
Knot tying
Knot slippage

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28
Q

What is suture pliability?

A

How easily suture bends

Ex: chromic stitch bends and unbends with greater pliability than steel stitch

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29
Q

Suture tissue drag?

A

How easily a suture slips through tissue

Ex: monofilament lower drag than multifilament

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30
Q

Suture knot tying?

A

How easily a suture can be tied

Ex: braided more difficult to tie

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31
Q

Suture knot slippage?

A

Ability of knots to be slid down suture

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32
Q

Tissue reaction?

A

Inflammation
Absorption
Infection potential
Allergic reaction

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33
Q

Whats covered on suture packaging?

A

Color coding

Length of suture
Needly type
Needle size and shape
# of needles in package

34
Q

3 sections of surgical needles?

A
  1. Swage - suture strand manufactured into needle end
  2. Body - can be round, triangular or flat
  3. Point - cutting or tapered or non cutting
35
Q

Conventional vs reverse cutting points?

A

Conventional (triangular) needles have a cutting edge on the inside

Reverse needles have a cutting edge and a non cutting edge

36
Q

Why have blunt needle tip?

A

Evolved due to bloodborne pathogen exposure due to needle sticks

37
Q

Threaded needles?

A

Less common than swaged

Eyed - needle is threaded with suture strand
Or
Spring/french eyed - suture is snapped through

38
Q

What is suture selection based on?

A 
Procedure 
Tissue being sutured
Type of re approxmation required
General condition of patient 
Surgeon preference
39
Q

What can suturing too tight cause?

A

Tissue strangulation

Poor surgical outcomes

40
Q

Interrupted suture?

A

Single sutures, tied independently

41
Q

Continuous running suture?

A

Uninterupted suture

42
Q

Retention suture?

A

Heavy suture reinforcing the primary suture line

43
Q

Subcuticular suture?

A

Suture under the epidermis

44
Q

Purse string suture?

A

Suture around a circular wound

45
Q

Advantages vs disadvantages of skin staples?

A 
Used on many incision types 
Ease of use
Uniform incisional tension
Faster wound closure 
Staple removal in easier

Vs

Not absorbable - have to be removed

46
Q

Skin adhesives?

A

Highly flammable

Option for surgical wound skin closures
Ex. Laparoscopic

47
Q

Advantages vs disadvantages to skin adhesives?

A

Reduced risk of infection
Less scarring
No removal

Vs

Limited to superficial wounds
Allergic reaction risk
Not good for conditions causing slow wound healing

48
Q

Adhesive tape strips?

Advantages vs disadvantages?

A

Used to approximate skin edges alone or on conjuntion with another closure

Less expensive

Vs

Tape can loosen and cause compromised healing

49
Q

Zipper closure?

Advantages vs disadvantages?

A

Used when wounds require skin stretching over area of tissue loss

Distributes over a wide surface area
Fast application
Lower infection rate
More cosmetic outcome

Vs

High cost
Not used in obese population

50
Q

Terninal end stapler?

A

Used to close the end of the colon after the SIDE TO END anatomosis

51
Q

Internal anatomosis stapler?

A

Used for side to bowel anastomosis

52
Q

End to end stapler?

A

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

53
Q

Steps of wound healing process?

A

Hemostasis
Inflammation
Proliferation
Remodeling

54
Q

Hemostasis stage of wound healing?

A 
Vascular constricton
Platelet aggregation 
- platelet adhesion 
Degranulation
- mast cell acitivation
Fibrin formation
- thrombus
55
Q

Inflammation stage of wound healing?

A

WBC infiltration

Edema
Phagocytosis
Hemostasis

56
Q

Proliferation phase of wound healing?

A

Blood vessel creation
Numerous cell type formations

Contraction
Collagen synthesis
Neovascularization
Epithelialization

57
Q

Types of Wound healing?

A

First intention/primary union
Second intention
Third intention/delayed primary closure

58
Q

Primary intention?

A

Normal surgical incison

Closed with suture or other product for clean approximated incison

59
Q

Common features of primary intention wound healing?

A

No tissue loss
Minimal or lack of post op swelling
No discharge or infection
Nominal scar formation

60
Q

Secondary intention wound healing?

A

Heals by granulation leading to wound contracture

Left open

61
Q

Common fratures of secondary intention?

A 
Infection 
Tissue loss
May occur due to necrotic tissue or patients compromised immune system 
Releated debridement may be necessary 
Scar formation and contracture

Heals from bottom up

62
Q

Third intention/delayed primary closure?

A

Delayed due to gross infection or considerable tissue loss

Wound is not devascularized in order ro promote healing

63
Q

Common features of third intention/delayed wound healing?

A

Wound is cleaned, debrided and packed
Abx used
Evebtual approximation of clean granulation surfaces
Wide, deep scar

Negative pressure therapy, packing

64
Q

Gun shot wounds?

A

High velocity > 2000ft/sec
Low < 2000ft/sec

Management:
Debridement
Irrigation
Stabilization of fracture

Wound clouse if < 8hrs
If > 8hrs wound closure 3-10 days after primary debridement

65
Q

Surgical factors affecting wound healing?

A 
Wound classification 
SSI
Patient health 
Surgical technique 
Post op considerations
66
Q

Class 1 - Clean wounds?

A

Clean operative wounds
No inflammation or infection
The resp, alimentary and GU tracts werent enerted
Elective surgeries 
Ex. Hernia repairs, breast surgery, non traumatic

67
Q

Class 2 - clean contaminated?

A

Operative wounds in which resp, alimentary or GU tract have been entered under controlled conditions without contamination

Chronic inflammation (not acute)

No infection or break in sterile technique

Ex. Abd hysterectomy, chole without spillage, elective appy

68
Q

Class 3 - contaminated?

A

Operative wounds invoving

  • open, fresh, traumatic wounds
  • major break in sterile texhnique
  • gross spillage from GI tract
  • acute non purulent inflammation

Ex. Traumatic wounds, laparotomy with spillage

69
Q

Class 4 - dirty infected

A

PUS/Purulent
Infection, abcess
Ruptured, perforated
Requires delayed primary closure

Ex. I&D, perforated viscera

70
Q

3 categories of SSIs?

A

Superficial incisional
Deep incisional
Organ/space

71
Q

Superficial incisional SSI?

A

Located in epidermis, dermis and subcu layers

Normally within 30 days post op

72
Q

Deep incisional SSI?

A

Fascial and muscle layers

Between 30-90 days post op

73
Q

Organ/space SSI?

A

Organ/space layer

Between 30-90 days post op

74
Q

How does patient health factors affect healing?

A 
Age 
- less muscle/skin turgor, weakened immunity 
Resp/circulatory status
- smoking
Pre existing conditions
- diab, immune compromised 
Nutrional status
- malnourished, obese
Immune system 
- allergy, immunocompromised
75
Q

What nutritional deficiencies affect wound healing?

A

Decifiency in:

  • vitamin A, B, C, K
  • protein, carbohydrates
  • zinc
76
Q

Surgical factors that lead to SSI?

A

Break in sterile technique
Poor tissue handling
- unnecessary pressure on tissue, blood vessel
Hemostasis methods
- cauterizing, lasers interupts circulation
Tissue approximation
- dead space = bacterial growth

77
Q

Post op considerararions affecting wound healing?

A 
Edema 
N/V
Coughing 
Pneumonia
Clot
78
Q

Debridement methods?

A

Surgical - sharp dissection, laser, hydrosurgical

Mechanical - forceful irrigation

Chemical - enzymatic agent

Biological - maggots

79
Q

Negative pressure wound therapy/VAC?

A

Constant, controlled pressure to wound

  • reduces edema
  • decreases the bacterial load
80
Q

What do skin substitutes do?

A

Produce growth factors and stimulate wound healing

Temporary treatment until permanent closure achieved

81
Q

What do drains do and what are two types?

A

Provide exit for serum, blood, air, etc from surgical site

Simple: penrose

Closed suction: JP, hemovac

Wound Healing (1 decks)

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