Wound Healing Flashcards
Primary intention
Wound edges approximated with sutures/staples allowing for regrowth of epithelial cover
Requirements for normal wound healing
- Good nutrition
- Absence of infection
- Good physiological condition
Wound healing in the first 2 weeks post-op
Collagen production and cross-linking going on. Until wound maturity, there is potential for injury and disruption of the wound
Hard, knot-like structure below the skin
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
Small sore red area w/intermittent drainage w/pus
Stitch abscess = low-grade persistent infection. Open and explore the wound with hemostat to remove infected suture
Fascial breakdown (dehiscence)
Ventral hernia may result from infection, suture failure, or fascial weakness
Raised scar
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
Hypertrophic scar that spreads outside the immediate area of incision
Keloid. Tx is the same as for hypertrophic scars.
Wound with redness and tenderness. Tx?
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
Secondary intention
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.
What is a split-thickness skin graft?
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
Third intention
Closure of a wound with sutures after resolution of infection
At what point does collagen achieve good tensile strength?
Cleavage of procollagen peptides and cross-linking takes place. In secondary intention, myofibroblasts contract as well to facilitate the closure.
Growth factors involved in wound healing
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
What are the 3 types of wound classifications
- Clean
- Clean-contaminated
- Contaminated (manage by leaving wound open and treat w/saline-soaked gauze)
No pre-op ABx
Clean surgical procedures and no permanent foreign bodies. ABx does not improve outcomes.
Pre-op ABx indicated
Used when there is predictable exposure to bacteria , implantation of device/prosthetic material, OR if host is immunosuppressed or has poor blood supply.
Dosing of pre-op ABx
Most effective when a single dose is given 1-hr pre-op and single dose given post-op.
Standard ABx prophylaxis
Amoxicillin PO or ampicillin IM/IV
ABx in pt allergic to penicillin
Clindamycin/cephalexin/azithromycin/clarithromycin
ABx in pt allergic to penicillin and cannot take PO
Clindamycin or Cefazolin
