Wound Healing 1

Question 0

Scar formation in healing by primary intention? Secondary intention? Tertiary intention?

Answer 0

Primary – minimal scar formation

Secondary – more pronounced visible scar and heavy overall scar formation

Tertiary – less pronounced visible scar and less overall scar formation

Question 1

Wound healing – primary intention? Secondary intention? Tertiary intention?

Answer 1

Primary – suturing or stapling to promote rapid reepithelialization

Secondary – wound left open leading to granulation tissue and scar formation

Tertiary – suturing only the skin, leaving the rest to heal the granulation tissue (delayed primary closure)

Question 2

Patient undergoes lysis of adhesions for small bowel obstruction – recommend not lifting significant weight until? Why?

Answer 2

Six weeks

Collagen production and cross-linking are still occurring (until collagen matures and reaches appropriate tensile strength, wound is prone to disruption)

Question 3

Patient undergoes lysis of adhesions for small bowel obstruction. Returns in three months because he feels the hard, knot-like structure beneath skin. Cause? Management?

Answer 3

Suture knot

If absorbable – will resolve with time

If non-absorbable – wait several more months for wound to completely heal before removing

Question 4

Patient undergoes lysis of adhesions for small bowel obstruction. Returns in three months because he has small, sore, red area that intermittently drains a small amount of pus – cause? Management?

Answer 4

Stitch abscess (infection of the suture)

Under local anesthesia, open wound with the hemostat to remove suture

Question 5

Patient undergoes lysis of adhesions for small bowel obstruction. Returns in three months because has a 4 cm defect in the fascia that bulges when he coughs – Cause? Due to? Management?

Answer 5

postoperative ventral hernia due to fascial breakdown (dehiscence)

Surgical repair

Question 6

Patient undergoes lysis of adhesions for small bowel obstruction. Returns in three months because scar is red and sensitive to touch. Management?

Answer 6

Some wounds have prolonged inflammatory processes in later stages of healing.

Reassure and observe for at least six months before considering revision

Question 7

Factors that slow wound healing?

Answer 7

1. Drugs – steroid, chemo, smoking
2. Metabolic – diabetes, jaundice, uremia
3. Malnutrition

Question 8

Patient undergoes lysis of adhesions for small bowel obstruction. Returns in three months because scar has a raised, hypertrophic appearance. Management?

Answer 8

1. Observed until scar stabilizes (most hypertrophic scars do not continue to enlarge)
2. Revision may be appropriate but needs to be treated with steroids and local pressure dressings to prevent recurrence

Question 9

Patient undergoes lysis of adhesions for small bowel obstruction. Returns in three months because score raised hypertrophic appearance and is spreading outside area of incision – Cause? Treatment?

Answer 9

Keloid – observation until scar stabilizes. Revision augmented with steroid injections and local pressure dressings

Question 10

25-year-old woman with bowel obstruction – performed a lysis of adhesions. POD3, find area of redness and tenderness in the middle of the wound. Likely diagnosis? Next step? Do not give? (Unless?)

Answer 10

Wound infection; drain the infection and the bride any nonviable tissue

Antibiotics; unless cellulitis appears to be spreading despite wound drainage

Question 11

25-year-old woman with bowel obstruction – performed a lysis of adhesions. POD3, find area of redness and tenderness in the middle of the wound. Wound is opened and purulent material is drained. Wound edges appear viable. Appropriate treatment? (Process involves in healing with this treatment?)

Answer 11

Daily application of moist gauze that further debrides necrotic tissue when removed - stimulates formation of granulation tissue

Healing by secondary intention

Question 12

Wounds that typically are healed by secondary intention?

Answer 12

1. Wounds that were contaminated at initial surgery and left open by surgeon
2. Wounds that become infected and required opening immediately post-surgery

Question 13

Idea behind wound healing by secondary intention? Disadvantages?

Answer 13

1. Allows bacteria to removed from wound (rather than accumulate as an abscess)
2. Granulation tissue forms leading to wound contraction and reepithelialization

Slow and often results in significant wound contraction

Question 14

Use of split-thickness skin graft?

Answer 14

Remote donor site that contains dermis and epidermis. It is capable of revascularizing from granulation tissue