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Surgery Exam 2 > Wound Healing > Flashcards

Wound Healing Flashcards

1
Q

wound

A

injury that breaks skin or other bodily tissues

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2
Q

surgical wound

A

cut or incision made during surgery
purposely made
minimal tissue damage

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3
Q

traumatic wound

A

sudden or unplanned injury
many wounds seen in ER/GP
bites, burns, lacerations

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4
Q

wound healing

A

biological process
replace devitalized tissue and missing cellular structures and tissue layers
restores tissue after injury

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5
Q

open (penetrating) wound

A

broken skin and exposed tissue
abrasion
laceration
puncture
avulsion
thermal wounds
surgical wounds or incisions

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6
Q

abrasion

A

open wound
skin rubs or scrapes against a rough/hard surface
loss of epidermis and portion of dermis
usually no significant bleeding
scrub and clean wound to avoid infection

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7
Q

laceration

A

open wound
cut or tear in skin, varies in severity and depth
if deep bleeding can be rapid and extensive

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8
Q

puncture

A

open wound
small hole/wound by long sharp object
minimal skin damage but underlying damage may be severe
may not bleed much, but can damage internal organs
higher risk of subsequent infection by contamination at time of puncture – dirty wound

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9
Q

avulsion

A

open wound
partial or complete tearing away of skin and tissue
traumatic injury, pieces of tissue torn and detached
bleed heavily and rapidly
crushing accidents, explosions, gunshots, head on collisions

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10
Q

closed (non penetrating) wounds

A

damage to tissue under intact skin
usually secondary to blunt trauma
injured tissue not exposed, but can be bleeding and damage to underlying muscle, internal organs, bones
contusion
hematoma
crushing injury

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11
Q

contusion

A

closed wound
blunt force trauma
does not break skin but causes damage to skin and underlying tissue
blood leaks from vessels
type of hematoma

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12
Q

hematoma

A

closed wound
collection (pooling) of blood outside a vessel

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13
Q

crushing injury

A

closed wound
force applied to area over period of time
commonly seen in bite wounds

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14
Q

degloving wound

A

severe injury
top layers of skin/tissue ripped away in dramatic fashion

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15
Q

other wounds

A

sinus tract injuries
burns
non healing wounds
open fractures
stings

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16
Q

wound healing

A

multiple processes continuously interacting
restore tissue after injury

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17
Q

factors that affect how well/quickly wound heals

A

environment/temperature – moisture favors bacteria
patient’s overall health
drug treatments

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18
Q

phase I of wound healing

A

inflammatory phase
immediately after injury (within 5-10 mins)
minimizing blood loss by hemostosis
vasoconstriction, platelet aggregation, clot formation, vasodilation, phagocytosis
platelets start wound healing process – cytokines

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19
Q

phase II of wound healing

A

proliferative phase
begins at 3-5 days, can last for several weeks
granulation contraction
epithelialization of injured tissue

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20
Q

phase III of wound healing

A

remodeling phase
begins at ~3 weeks, can last weeks to months
formation of new collagen
wound tissue strengthening
scar formation

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21
Q

6 basic steps of wound care

A
  1. prevention of further wound contamination (lavage)
  2. debridement of dead/dying tissue
  3. removal of foreign debris and contaminants
  4. provision of adequate wound drainage
  5. promotion of viable vascular bed
  6. selection of appropriate method of closure
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22
Q

patient assessment

A

-hemodynamic stability – make sure patient stable before attending to wound
-hydration
-pain sensation, neuro function – important in limb injuries
-body condition
-organ dysfunction
-anemia – evidence of sepsis
-provide analgesia

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23
Q

wound classification – clean

A

non contaminated, non traumatic, non inflamed surgical sites
GI, urinary, repsiratory tract not entered
surgical wound
aseptic technique maintained
tissues not predisposed to infection

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24
Q

wound classification – clean-contaminated

A

GI, urinary, respiratory tracts entered under controlled conditions without unusual contamination
aseptic technique, no spillage of organ contents
some acute traumatic wounds that have been cleaned
minor break in sterility
placement of a drain in a “clean” wound

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25
Q

wound classification – contaminated

A

surgery where GI contents or infected urine spill into an open cavity
major break in aseptic technique
open fractures
penetrating wounds
new open traumatic wounds/lacerations
antibiotics and lavage +/- debridement

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26
Q

wound classification – dirty and infected

A

heavily contaminated/infected
purulent discharge, foreign material
abscesses
traumatic wounds > 12 hours after injury
surgery where hollow organ/viscera perforated or fecal contamination occurs
gross spillage of contamianted body contents
antibiotics, lavage, debridement, drainage, +/- bandage

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27
Q

initial approach of wound cleaning

A

protect with occlusive bandage
provide analgesia
drug therapy – antibiotics
wear gloves
fill wound with water soluble lube – prevent hairs from getting it while clipping
clip and clean with wide margins
do not use scrub in wound bed

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28
Q

lavage

A

keep tissue hydrated
reduce bacterial contamination
remove necrotic debris
dilution is the solution to pollution
culture after lavage
do not lavage puncture wounds

29
Q

why culture after lavage?

A

if do it before will just get significant contamination, will not get an accurate reading

30
Q

surgical debridement

A

freshening edges – scalpel blade, may be some active bleeding
sometimes only indicated in preparation for wound closure

31
Q

chemical (enzymatic) debridement

A

very expensive, not painful (no analgesia)
poor anesthetic patients, minimal debridement
very slow, not good for large wounds

32
Q

mechanical (bandaging) debridement

A

traps devitalized tissue in primary layer of bandage
wet to dry vs dry to dry
materials inexpensive
painful – materials stick to bandage
have to change at least once per day

33
Q

biosurgical debridement

A

maggot therapy – maggots eat dead tissue

34
Q

what to debride

A

contaminated SQ fat
shredded fascia
macerated muscle
devitalized skin
skin edges (3-5 mm)

35
Q

what not to debride

A

direct cutaneous vessels
hypodermis
cutaneous muscles
bones with attachments
ligament attached to bone
nerves
other vital structures

36
Q

what determines wound management plan

A

wound classification
time since injury
location of wound
degree of contamination
degree of tissue trauma
extent of tension or dead space
blood supply of wound
clinical condition of patient
results after debridement and lavage

37
Q

wound closure – first intention

A

-primary closure
-within a few hours after injury (6-8 hours)
-best choice for healthy wounds in well vascularized areas
-closed within 24 hours of injury with sutures or staples
-minimal edema
-no local infection or serous discharge
-minimal scar formation
-healing rapid
-clean surgical or fresh traumatic wound after cleaning (clean-contaminated)

38
Q

should you close a contaminated wound

A

aggressively debride
good blood supply
no evidence of established infection
less than 6 hours old

39
Q

wound closure – third intention

A

-delayed primary closure (18-24 hours)
-start wound management at 6-8 hours post injury
-prior to granulation formation
-wounds sutured closed before granulation tissue forms
-moderate to marked tissue edema
-older wounds
-questionable viability
-debride
-significant swelling and/or skin tension
-best for infected or unhealthy wounds that are too contaminated for primary closure
-appear clean and well vascularized in 3-5 days
-don’t use for dirty or significantly contaminated wounds
-contaminated or infected wounds, extremity wounds, wounds from blunt trauma

40
Q

wound closure – secondary closure

A

-after granulation tissue present
-wound closure > 5 days after injury
-medical management of wound initially, then surgical closure
-ensure wound in clear of infection before closing
-excision of epithelialized edges and some granulation tissue may be required
-recommended for infected wounds or large wounds
-if primary closure fails can then use secondary closure

41
Q

wound closure – second intention

A

-non closure
-contraction and epithelialization
-secondary wound healing or spontaneous healing
-wound is left open
-some may be surgically closed later (secondary closure)
-recommended when patient is poor anesthetic candidate, infected wounds, large wounds
-risk of contracture formation – proud flesh in horses
-moderate to small trunk wounds or burns
-abscesses – can’t clear with initial lavage (don’t want to suture bacteria into body)
-distal extremity wounds – not enough skin
-fistulae
-takes a long time, expensive

42
Q

wound closure – epithelialization

A

healing of partial thickness wounds (includes first degree burns and abrasions)

43
Q

golden period

A

wound treated within 6-8 hours after injury
bacterial levels not multiplied to critical numbers yet
tissues not infected

44
Q

should wounds treated after the golden period be closed

A

no
infection is likely

45
Q

tissue viability

A

don’t want to suture dead/necrotic tissue into patient
attachment
color
texture
temperature

46
Q

bandaging

A

covers drains and wounds
reduces dead space and edema
debrides wounds (mechanically)
vehicle for antiseptic
immobilization
cleanliness
holds dressing in place

47
Q

primary layer of bandage – dressing

A

directly on wound
gauze or mesh material that promotes early healing
allows fluid to pass through secondary layer and prevents tissue from drying out

48
Q

secondary layer of bandage

A

absorbs fluid
pads the wound
decreases dead space
supports or immobilizes limbs
frequently cast padding or roll gauze

49
Q

tertiary (outer) layer of bandage

A

provides some pressure on wound
holds inner layers in place
protects inner layers from environment
usually adhesive tape or elastic wraps (vet wrap)

50
Q

hydrophilic foam

A

hydrophilic dressing
maintains moist wound environment
not too moist – bacteria
not too dry – kills tissues
low adherence to wound surface
high fluid handling capacity
decreased bandage changes
decreased tissue maceration

51
Q

topical agents – granulated sugar

A

inflammatory to early repair phase
hyperosmotic
requires frequent bandage changes
exudative wounds
decreased bacterial proliferation
promotes debridement and granulation/epithelialization
1 cm thick layer
SID to TID bandage changes

52
Q

topical agents – honey

A

inflammatory to early repair phase
hyperosmotic effect may damage healthy tissues
requires frequent bandage changes
manuka honey – properties that promote wound healing
promotes debridement, granulation, epithelialization
reduces edema and inflammation
easy to acquire and store, inexpensive
messy

53
Q

topical agents – silver

A

inflammatory and repair phases
no clinical evidence of resistance

54
Q

topical agents – antibiotics

A

inflammatory and repair phases
broad spectrum
may also supply zinc to the wound environment

55
Q

topical agents – enzymatic agents

A

inflammatory phase
slow, expensive

56
Q

topical agents – biologic (maggots)

A

inflammatory phase
selective debridement
requires specialized dressing to contain the maggots

57
Q

when to place a drain

A

in place 3-7 days
when dead space cannot be eliminated
when fluid accumulation likely
when infection present

58
Q

passive drains

A

relies on gravity, pressure differentials, overflow to move fluid/gas
fluid exits around tube at incision site

59
Q

active drains

A

apply artificial pressure gradient to pull fluid/gas from wound
involves suction

60
Q

management of cuts, tears, lacerations

A

usually complete closure
damage to muscles, tendons, or other tissues must be treated before wound closure

61
Q

management of degloving injuries

A

usually requires bandaging

62
Q

management of puncture wounds

A

leave open
explore? possibility of underlying trauma

63
Q

managemnet of abscesses

A

establish draining
lavage copiously
warm compresses
antibiotics?

64
Q

management of open fractures

A

rapid wound care and culture
bandage/splint
antibiotics
analgesics
surgery consultation ASAP

65
Q

complications – seroma

A

layered wound closure
drains

66
Q

complications – infection

A

debridement
antimicrobials
+/- supportive care

67
Q

complications – dehiscence

A

tissue viability
closure technique

68
Q

complications – failure to heal

A

patient status
closure method

Surgery Exam 2 (6 decks)

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