Wound Healing Flashcards
Advantages of primary wound healing.
Ease in wound care
Faster
return of function
Better cosmetic reusults
Wound is left open and granulation tissue forms and there is eventual coverage of the defect by wound contraction
Secondary wound healing
Disadvantages of secondary wound healing
complicated wound care
possible bad cosmetic outcome
What are advantages of secondary wound healing
Wound infection virtually impossible (use in contaminated wounds)
Wound left open
Closed after about 5 days of wound care
Tertiary wound healing (delayed primary closure)
Phases of wound healing
Inflammatory (substrate) Phase
Proliferative
Maturation (remodeling)
Would healing stage where wound look edematous, takes apprx 4 days (if closed primarily)
inflammatory (substrate) phase
when does the proliferative phase occur?
wound is covered with epithelium
Production of collagen
Scar is raised, red and hard
When the scar flattens and becomes less prominent, what stage is it in?
Maturation (remodeling) phase
what is where the tissue repair is prolonged and pathologic.
Chronic wound
Skin violated by shearing force
Flap or total skin loss
Avulsion wound
should you close a contaminated wound?
No if there is high bacteria inoculum, long time from injury (>4 hours), crush injury
Why can you wait longer to closer an injury on the face?
Less chance of infection due to bleeding (can go 8-10 hours before closing)
Are systemic antibiotics helpful for an infected wound?
No, not unless cellulitis or signs of sepsis
what inhibit wound healing?
hypoxia and ischemia infection edema pressure fecal soiling
what can be done to improve wound healing?
clean
debride
close
control bleeding
what vitamin helps collagen form?
folic acid
what does vitamin A help with?
inflammatory response
collagen
macrophages
What does MG help with
protein synthesis
What does zinc help with
cofactor for RNA and DNA synthesis
what does hyperglycemia do to wound healing?
Impaired wound healing
Collagen formation
Inhibits fibroblast and endothelial cell proliferation in the wound
how do steroids affect wound healing?
Blunt inflammatory response
Decrease available vitamin A in wound
Alter deposition and remodeling of collagen
how does smoking affect wound healing?
Decreases O2 carrying capacity of Hgb
Decrease collagen formation in wounds
when is a pressure ulcer unstagable?
Full depth is unknown as ulcer base is not visible.
do you want a wound to be wet or dry?
wet
what is a cream that debrides fibrous exudate
enzymatic debriding
Wound on medial malleolus, complain of swelling, varicose veins, achy, itchy legs, woody appearance
Venous stasis ulcers
Most common chronic wounds in adults
Venous stasis ulcers
Tx for venous stasis ulcers
Compression Elevation \+/- debridement \+/- abx Vein ligation
What are the 5 P’s of arterial insufficiency ulcers?
pain, pallor, pulslessness, parasthesias, paralysis
where do arterial insufficiency ulcers typically occur?
typically toes but can occur anywhere foot, ankle or leg
What is a foot that looks very swollen
Charcot foot
How do you treat arterial insufficiency treatment?
revascularization
how do you tx claudication?
get them walking, antiplatelets, stop smoking
Widening or unsightly scar that does not extend beyond the original boundaries of the wound
Hypertrophic scar
how do you tx a hypertrophic scar?
excision if initial closure was unusual
steroid injection
An abnormal scar that grows beyond the boundaries of the original site of skin injury
Keloid
who are keloid scars seen more often in?
darker pigemented skin
What type organisms usually infect skin and subQ?
Gram +
What do you give to tx skin and sub Q infections?
oral abx
How do you tx deep incisional surgical site infections (SSI)? (polymicrobial)
opening wound +/- debridement
abx
Tx for organ/intracavitary space (polymicrobial)
drainage
IV abx
What is an example of a clean case (only break the skin)
thyroid
example of a clean contaminated case
Colon resection (w/ minimal spillage) gallbladder
What is an example of a contaminated case
Small bowel resection w/ lots of spillage
infected bile w/ chole
what is an example of a dirty case?
perf diverticulitis
what should you do for skin prep?
Clip, don’t shave body hair
ppovidone-iodine or chlorhexidine containing solutions
adhesive sterile drapes
what do preoperative abx help with?
decrease SSI rate by >30%
must give w/i an hour of incision (before)
will you use preop abx in clean cases?
No, unless prosthetic is used
for an elective colon resection will you continue abx for 2 weeks post op?
No (as long as no perf bowel)
What does SCIP stand for?
Surgical Care Improvement Program
