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Surgery > Wound Healing > Flashcards

Wound Healing Flashcards

1
Q

What are the three phases of wound healing?

A

Inflammatory/substrate
Proliferative
Maturation/remodeling

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2
Q

What is primary wound healing?

A

Healing by primary intention- Tissue is anatomically re-approximated

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3
Q

What are the advantages of primary wound healing?

A

Ease in wound care
Faster return of function
Better cosmetic results

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4
Q

What are the disadvantages if primary wound healing?

A

Risk of wound infection

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5
Q

What is secondary wound healing?

A

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

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6
Q

What are the advantages of secondary wound healing?

A

Infection is virtually impossible

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7
Q

What are the disadvantages of secondary wound healing?

A

Complicated wound care

Bad cosmetic outcome

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8
Q

When should secondary wound healing be used?

A

When there is a highly-contaminated wound

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9
Q

What is tertiary wound healing?

A

Wound is left open
Closed about 5 days of wound care
Abundant granulation tissue
Rarely done

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10
Q

What cells are found during the inflammatory phase of wound healing?

A

PMNs, platelets, macrophages

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11
Q

How does the wound appear during the inflammatory phase of wound healing?

A

Edematous and erythematous

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12
Q

How long does the inflammatory phase of wound healing take?

A

Approx 4 days

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13
Q

When does the proliferative phase of wound healing take place?

A

Only once wound is covered in epithelium

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14
Q

What is produced during the proliferative phase?

A

Collagen

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15
Q

How does the wound appear during the proliferative phase?

A

Raised, red, and hard scar

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16
Q

What is the maturation phase of wound healing?

A

Maturation of collagen by intermolecular cross-linking

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17
Q

How does the wound appear during the maturation phase?

A

It flattens, becomes less prominent, and more pale and supple.

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18
Q

What is a clean wound?

A

A new wound

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19
Q

What is an avulsion wound?

A

Skin violated by shearing force with a flap or total skin loss

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20
Q

What are the five classifications of wounds?

A 
Clean
Avulsion
Abrasion
Puncture
Crush
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21
Q

Under what circumstances should you not close a contaminated wound?

A

If high bacteria inoculum as in human bites or farm injury.
If it has been >4 hours since injury
If it is a crush injury

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22
Q

What classifies an infected wound?

A

Contamination >10^5 organisms per gram of tissue

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23
Q

Should systemic abx be used for contaminated wounds?

A

Not helpful unless cellulitis or signs of sepsis, but might use topical abx

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24
Q

What factors inhibit wound healing?

A 
Hypoxia/ischemia 
Wound infection
Edema
Pressure
Fecal soiling
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25
Q

What vitamin aides in collagen formation

A

C

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26
Q

What vitamin helps clotting?

A

K

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27
Q

What Vitamin helps the inflammatory response, collage, and macrophags?

A

A

28
Q

What mineral helps protein synthesis?

A

Mg

29
Q

What mineral is a cofactor for RNA and DNA synthesis?

A

Zinc

30
Q

What factors of wound healing does hyperglycemia inhibit?

A

collagen formation, fibroblast and endothelial cell proliferation in the wound

31
Q

How do steroids affect wound healing?

A

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

32
Q

How does chronic illness affect wound healing?

A

Predispose to infection and malnutrition

33
Q

In which phase are chronic wounds stalled?

A

Inflammatory phase

34
Q

Stage I pressure ulcer

A

Unblanchable erythema

35
Q

Stage II pressure ulcer

A

Partial thickness skin loss

36
Q

Stage III pressure ulcer

A

Full thickness skin loss

37
Q

Stage IV pressure ulcer

A

Full thickness skin loss with involved supporting structures

38
Q

How do you characterize a wound?

A

Size, depth, extend of undermining
Necrotic or viable surface?
Amount/characteristic of exudate
Status of periwound tissues

39
Q

What are the most common chronic wounds in the adult?

A

Venous stasis ulcer

40
Q

What are other symptoms of venous stasis?

A

Leg discomfort, vericose veins, hyperpigmentation

41
Q

Where are venous stasis ulcers most commonly found?

A

Anterior medial malleolus

42
Q

How are venous stasis ulcers treated?

A 
Compression
Elevation
Debridement (+/-)
Abx (+/-)
Vein Ligation
43
Q

What are arterial insufficiency ulcers caused by?

A

Atherosclerosis

44
Q

Where do arterial insufficiency ulcers usually appear?

A

Toes but can be anywhere on the foot, ankle, or leg

45
Q

What are other features of an arterial insufficiency ulcer?

A

Dry or wet gangrene, cool skin, limb loss

46
Q

What are the 5 p’s of arterial insufficiency ulcers?

A

Pain, pallor, pulselessness, paresthesias, paralysis

47
Q

How are arterial insufficiency ulcers treated?

A

Revascularization, amputation

48
Q

What three features are common in diabetic neuropathic ulcers?

A

Hyperglycemia, Arterial disease, a site of increased weight bearing

49
Q

How are diabetic neuropathic ulcers treated?

A 
Control infection
Debridement
Special shoes
Arterial revascularization
wound care
amputation
50
Q

What are the three most important factors in formation of the ideal scar?

A
  • Accurate alignment of sharply incised tissue parallel to the natural lines of resting skin tension
  • Closure of wound without tension on epidermis
  • Primary healing without complications
51
Q

What is a hypertrophic scar?

A

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

52
Q

How is a hypertrophic scar treated?

A

Can be excised if initial closure was unusual

steroid injection

53
Q

What is a keloid?

A

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

54
Q

How are keloids treated?

A

Excision + injected steroids

55
Q

What type of organism is found in an infected surgical incision of the skin and subQ tissue?

A

Gram +

56
Q

How is cellulitis treated?

A

Oral abx

57
Q

How is a superficial abscess that is above fascia of the wound bed treated?

A

Re-opening of the wound with or without abx

58
Q

What type of organisms are in a deep incisional surgical site infection?

A

Polymicrobial

59
Q

How is a deep incisional surgical site infection treated?

A

Open the wound with or without debridement, abx

60
Q

How is a surgical site infection of the organs or intracavitary space treated?

A

Drainage, IV abx

61
Q

What is a clean-case?

A

Elective, non-traumatic surgery, primarily closed, no acute inflammation, no break in technique, no entry of respiratory, GI, biliary, or GU tracts

62
Q

What is a clean-contaminated case?

A

An elective opening of the respiratory, GI, biliary, or GU tract with minimal spillage, not contacting infected urine or bile, minor technique break

63
Q

What is a contaminated case?

A

Non-purulent inflammation, gross spillage from GI tract, entrance into biliary or GU tract with infected bile/urine, major break in technique, penetrating trauma <4 hrs old, chronic open wounds to be grafted or covered

64
Q

What is a dirty case?

A

Purulent inflammation, preoperative perforation of resp, GI, biliary or GU tract, penetrating trauma >4 hours old

65
Q

When are perioperative abx used?

A

1 hr before incision
Continue postop for no more than 24 hrs or not at all
Dirty cases require prolonged abx

66
Q

No abx in clean cases unless:

A

a prosthetic is used

67
Q

Which types of surgeries require pre-op antibiotics?

A

clean-contaminated, contaminated, and dirty cases

Surgery (10 decks)

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