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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
Suture knot tensile strength?
Breaking point of a knotted suture Sutures are 10-40% weaker after being tied
26
Examples of absorbable sutures?
Monocryl (used closed to skin) Vicryl PDS (deep)
27
Handling characteristics of a suture?
Pliability Tissue drag Knot tying Knot slippage
28
What is suture pliability?
How easily suture bends Ex: chromic stitch bends and unbends with greater pliability than steel stitch
29
Suture tissue drag?
How easily a suture slips through tissue Ex: monofilament lower drag than multifilament
30
Suture knot tying?
How easily a suture can be tied Ex: braided more difficult to tie
31
Suture knot slippage?
Ability of knots to be slid down suture
32
Tissue reaction?
Inflammation Absorption Infection potential Allergic reaction
33
Whats covered on suture packaging?
Color coding Length of suture Needly type Needle size and shape # of needles in package
34
3 sections of surgical needles?
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
Conventional vs reverse cutting points?
Conventional (triangular) needles have a cutting edge on the inside Reverse needles have a cutting edge and a non cutting edge
36
Why have blunt needle tip?
Evolved due to bloodborne pathogen exposure due to needle sticks
37
Threaded needles?
Less common than swaged Eyed - needle is threaded with suture strand Or Spring/french eyed - suture is snapped through
38
What is suture selection based on?
``` Procedure Tissue being sutured Type of re approxmation required General condition of patient Surgeon preference ```
39
What can suturing too tight cause?
Tissue strangulation | Poor surgical outcomes
40
Interrupted suture?
Single sutures, tied independently
41
Continuous running suture?
Uninterupted suture
42
Retention suture?
Heavy suture reinforcing the primary suture line
43
Subcuticular suture?
Suture under the epidermis
44
Purse string suture?
Suture around a circular wound
45
Advantages vs disadvantages of skin staples?
``` 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
Skin adhesives?
Highly flammable Option for surgical wound skin closures Ex. Laparoscopic
47
Advantages vs disadvantages to skin adhesives?
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
Adhesive tape strips? | Advantages vs disadvantages?
Used to approximate skin edges alone or on conjuntion with another closure Less expensive Vs Tape can loosen and cause compromised healing
49
Zipper closure? | Advantages vs disadvantages?
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
Terninal end stapler?
Used to close the end of the colon after the SIDE TO END anatomosis
51
Internal anatomosis stapler?
Used for side to bowel anastomosis
52
End to end stapler?
Used in a multi step procedure with the end result of achieving an internal anastomosis of hollow organ space
53
Steps of wound healing process?
Hemostasis Inflammation Proliferation Remodeling
54
Hemostasis stage of wound healing?
``` Vascular constricton Platelet aggregation - platelet adhesion Degranulation - mast cell acitivation Fibrin formation - thrombus ```
55
Inflammation stage of wound healing?
WBC infiltration Edema Phagocytosis Hemostasis
56
Proliferation phase of wound healing?
Blood vessel creation Numerous cell type formations Contraction Collagen synthesis Neovascularization Epithelialization
57
Types of Wound healing?
First intention/primary union Second intention Third intention/delayed primary closure
58
Primary intention?
Normal surgical incison Closed with suture or other product for clean approximated incison
59
Common features of primary intention wound healing?
No tissue loss Minimal or lack of post op swelling No discharge or infection Nominal scar formation
60
Secondary intention wound healing?
Heals by granulation leading to wound contracture Left open
61
Common fratures of secondary intention?
``` 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
Third intention/delayed primary closure?
Delayed due to gross infection or considerable tissue loss | Wound is not devascularized in order ro promote healing
63
Common features of third intention/delayed wound healing?
Wound is cleaned, debrided and packed Abx used Evebtual approximation of clean granulation surfaces Wide, deep scar Negative pressure therapy, packing
64
Gun shot wounds?
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
Surgical factors affecting wound healing?
``` Wound classification SSI Patient health Surgical technique Post op considerations ```
66
Class 1 - Clean wounds?
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
Class 2 - clean contaminated?
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
Class 3 - contaminated?
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
Class 4 - dirty infected
PUS/Purulent Infection, abcess Ruptured, perforated Requires delayed primary closure Ex. I&D, perforated viscera
70
3 categories of SSIs?
Superficial incisional Deep incisional Organ/space
71
Superficial incisional SSI?
Located in epidermis, dermis and subcu layers Normally within 30 days post op
72
Deep incisional SSI?
Fascial and muscle layers Between 30-90 days post op
73
Organ/space SSI?
Organ/space layer Between 30-90 days post op
74
How does patient health factors affect healing?
``` 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
What nutritional deficiencies affect wound healing?
Decifiency in: - vitamin A, B, C, K - protein, carbohydrates - zinc
76
Surgical factors that lead to SSI?
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
Post op considerararions affecting wound healing?
``` Edema N/V Coughing Pneumonia Clot ```
78
Debridement methods?
Surgical - sharp dissection, laser, hydrosurgical Mechanical - forceful irrigation Chemical - enzymatic agent Biological - maggots
79
Negative pressure wound therapy/VAC?
Constant, controlled pressure to wound - reduces edema - decreases the bacterial load
80
What do skin substitutes do?
Produce growth factors and stimulate wound healing Temporary treatment until permanent closure achieved
81
What do drains do and what are two types?
Provide exit for serum, blood, air, etc from surgical site Simple: penrose Closed suction: JP, hemovac

Wound Healing (1 decks)

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