Wound Healing

Question 1

Advantages of primary wound healing.

Answer 1

Ease in wound care
Faster
return of function
Better cosmetic reusults

Question 2

Wound is left open and granulation tissue forms and there is eventual coverage of the defect by wound contraction

Answer 2

Secondary wound healing

Question 3

Disadvantages of secondary wound healing

Answer 3

complicated wound care

possible bad cosmetic outcome

Question 4

What are advantages of secondary wound healing

Answer 4

Wound infection virtually impossible (use in contaminated wounds)

Question 5

Wound left open

Closed after about 5 days of wound care

Answer 5

Tertiary wound healing (delayed primary closure)

Question 6

Phases of wound healing

Answer 6

Inflammatory (substrate) Phase
Proliferative
Maturation (remodeling)

Question 7

Would healing stage where wound look edematous, takes apprx 4 days (if closed primarily)

Answer 7

inflammatory (substrate) phase

Question 8

when does the proliferative phase occur?

Answer 8

wound is covered with epithelium
Production of collagen
Scar is raised, red and hard

Question 9

When the scar flattens and becomes less prominent, what stage is it in?

Answer 9

Maturation (remodeling) phase

Question 10

what is where the tissue repair is prolonged and pathologic.

Answer 10

Chronic wound

Question 11

Skin violated by shearing force

Flap or total skin loss

Answer 11

Avulsion wound

Question 12

should you close a contaminated wound?

Answer 12

No if there is high bacteria inoculum, long time from injury (>4 hours), crush injury

Question 13

Why can you wait longer to closer an injury on the face?

Answer 13

Less chance of infection due to bleeding (can go 8-10 hours before closing)

Question 14

Are systemic antibiotics helpful for an infected wound?

Answer 14

No, not unless cellulitis or signs of sepsis

Question 15

what inhibit wound healing?

Answer 15

hypoxia and ischemia
infection
edema
pressure
fecal soiling

Question 16

what can be done to improve wound healing?

Answer 16

clean
debride
close
control bleeding

Question 17

what vitamin helps collagen form?

Answer 17

folic acid

Question 18

what does vitamin A help with?

Answer 18

inflammatory response
collagen
macrophages

Question 19

What does MG help with

Answer 19

protein synthesis

Question 20

What does zinc help with

Answer 20

cofactor for RNA and DNA synthesis

Question 21

what does hyperglycemia do to wound healing?

Answer 21

Impaired wound healing
Collagen formation
Inhibits fibroblast and endothelial cell proliferation in the wound

Question 22

how do steroids affect wound healing?

Answer 22

Blunt inflammatory response
Decrease available vitamin A in wound
Alter deposition and remodeling of collagen

Question 23

how does smoking affect wound healing?

Answer 23

Decreases O2 carrying capacity of Hgb

Decrease collagen formation in wounds

Question 24

when is a pressure ulcer unstagable?

Answer 24

Full depth is unknown as ulcer base is not visible.

Question 25

do you want a wound to be wet or dry?

Answer 25

wet

Question 26

what is a cream that debrides fibrous exudate

Answer 26

enzymatic debriding

Question 27

Wound on medial malleolus, complain of swelling, varicose veins, achy, itchy legs, woody appearance

Answer 27

Venous stasis ulcers

Question 28

Most common chronic wounds in adults

Answer 28

Venous stasis ulcers

Question 29

Tx for venous stasis ulcers

Answer 29

``` Compression Elevation +/- debridement +/- abx Vein ligation ```

Question 30

What are the 5 P's of arterial insufficiency ulcers?

Answer 30

pain, pallor, pulslessness, parasthesias, paralysis

Question 31

where do arterial insufficiency ulcers typically occur?

Answer 31

typically toes but can occur anywhere foot, ankle or leg

Question 32

What is a foot that looks very swollen

Answer 32

Charcot foot

Question 33

How do you treat arterial insufficiency treatment?

Answer 33

revascularization

Question 34

how do you tx claudication?

Answer 34

get them walking, antiplatelets, stop smoking

Question 35

Widening or unsightly scar that does not extend beyond the original boundaries of the wound

Answer 35

Hypertrophic scar

Question 36

how do you tx a hypertrophic scar?

Answer 36

excision if initial closure was unusual | steroid injection

Question 37

An abnormal scar that grows beyond the boundaries of the original site of skin injury

Answer 37

Keloid

Question 38

who are keloid scars seen more often in?

Answer 38

darker pigemented skin

Question 39

What type organisms usually infect skin and subQ?

Answer 39

Gram +

Question 40

What do you give to tx skin and sub Q infections?

Answer 40

oral abx

Question 41

How do you tx deep incisional surgical site infections (SSI)? (polymicrobial)

Answer 41

opening wound +/- debridement | abx

Question 42

Tx for organ/intracavitary space (polymicrobial)

Answer 42

drainage | IV abx

Question 43

What is an example of a clean case (only break the skin)

Answer 43

thyroid

Question 44

example of a clean contaminated case

Answer 44

``` Colon resection (w/ minimal spillage) gallbladder ```

Question 45

What is an example of a contaminated case

Answer 45

Small bowel resection w/ lots of spillage | infected bile w/ chole

Question 46

what is an example of a dirty case?

Answer 46

perf diverticulitis

Question 47

what should you do for skin prep?

Answer 47

Clip, don't shave body hair ppovidone-iodine or chlorhexidine containing solutions adhesive sterile drapes

Question 48

what do preoperative abx help with?

Answer 48

decrease SSI rate by >30% | must give w/i an hour of incision (before)

Question 49

will you use preop abx in clean cases?

Answer 49

No, unless prosthetic is used

Question 50

for an elective colon resection will you continue abx for 2 weeks post op?

Answer 50

No (as long as no perf bowel)

Question 51

What does SCIP stand for?

Answer 51

Surgical Care Improvement Program