Wound Healing

Question 1

Primary intention

Answer 1

Wound edges approximated with sutures/staples allowing for regrowth of epithelial cover

Question 2

Requirements for normal wound healing

Answer 2

1. Good nutrition
2. Absence of infection
3. Good physiological condition

Question 3

Wound healing in the first 2 weeks post-op

Answer 3

Collagen production and cross-linking going on. Until wound maturity, there is potential for injury and disruption of the wound

Question 4

Hard, knot-like structure below the skin

Answer 4

Suture knot. If absorbable sutures were placed then wait it out. If nonabsorbable sutures used then wait several months until complete recovery and then the knot may be removed if pt is unhappy

Question 5

Small sore red area w/intermittent drainage w/pus

Answer 5

Stitch abscess = low-grade persistent infection. Open and explore the wound with hemostat to remove infected suture

Question 6

Fascial breakdown (dehiscence)

Answer 6

Ventral hernia may result from infection, suture failure, or fascial weakness

Question 7

Raised scar

Answer 7

Hypertrophic scars remain within normal limits of the incision. These warrant observation until the scar has stabilized. These may be revised and will often recur unless the wound is treated w/steroids and pressure dressings

Question 8

Hypertrophic scar that spreads outside the immediate area of incision

Answer 8

Keloid. Tx is the same as for hypertrophic scars.

Question 9

Wound with redness and tenderness. Tx?

Answer 9

Wound infection. Tx = draining the infection and debridement of any nonviable tissue. ABx are only necessary if the wound cellulitis is spreading despite drainage. Daily moist guaze placement to stimulate granulation tissue and healing

Question 10

Secondary intention

Answer 10

used for wounds that were contaminated at initial surgery and became infected requiring opening postoperatively. This approach allows for bacterial removal from wound rather than accumulation into abscess. This process is characterized by formation of granulation tissue which fills the cavity followed by reepithelialization and contraction.

Question 11

What is a split-thickness skin graft?

Answer 11

It is a piece of skin from a donor site that contians a layer of epidermis and dermis that may revascularize from granulation tissue via “inosculation” to facilitate reepithilialization of the wound preventing wound contraction and facilitating wound closure

Question 12

Third intention

Answer 12

Closure of a wound with sutures after resolution of infection

Question 13

At what point does collagen achieve good tensile strength?

Answer 13

Cleavage of procollagen peptides and cross-linking takes place. In secondary intention, myofibroblasts contract as well to facilitate the closure.

Question 14

Growth factors involved in wound healing

Answer 14

PDGF - chemotactic for fibroblasts, No, Mo
TGF-B - increases collagen synth and follows PDGF
FGF - hastens wound contraction
EGF - stimulates spithelial migration and mitosis, speeding up wound epithelialization

Question 15

What are the 3 types of wound classifications

Answer 15

1. Clean
2. Clean-contaminated
3. Contaminated (manage by leaving wound open and treat w/saline-soaked gauze)

Question 16

No pre-op ABx

Answer 16

Clean surgical procedures and no permanent foreign bodies. ABx does not improve outcomes.

Question 17

Pre-op ABx indicated

Answer 17

Used when there is predictable exposure to bacteria , implantation of device/prosthetic material, OR if host is immunosuppressed or has poor blood supply.

Question 18

Dosing of pre-op ABx

Answer 18

Most effective when a single dose is given 1-hr pre-op and single dose given post-op.

Question 19

Standard ABx prophylaxis

Answer 19

Amoxicillin PO or ampicillin IM/IV

Question 20

ABx in pt allergic to penicillin

Answer 20

Clindamycin/cephalexin/azithromycin/clarithromycin

Question 21

ABx in pt allergic to penicillin and cannot take PO

Answer 21

Clindamycin or Cefazolin