Wound healing

Question 1

3) Meticulous attention paid to hemostasis intraoperatively

Answer 1

i. Blood loss (reported on brief intra-op report)

ii. Hematoma formation can precipitate infection, re-operation,

Question 2

5) Bovie

Answer 2

intraoperative hemostasis, electrical current or “coag” setting which denatures proteins causing formation of coagulation.

Question 3

6) Phases of wound healing.

(Inflammatory phase

Answer 3

Fibroplasia and matrix synthesis

0-3days)
-new skin matrix deposited. Lactate and reduced oxygen attract
fibroblasts and growth factors.

Question 4

Proliferation Phase

Answer 4

(3-21 days)

• Angiogenesis(neovascularization) blood flow established across the wound=4days
• Epithelialization= new skin cells, wound has tensile strength and pts can bath=5days, moisture is key

Question 5

Remodeling

Answer 5

(21 days- 18mos) scar contracts, smaller, thinner in

Dermis

Question 6

8) Some conditions leading to reduced oxygenation?

Answer 6

i. COPD
ii. Emphysema
iii. Asthma
iv. Pneumonia

Question 7

9) Wound classificatios?

Answer 7

a. Primary= clean wound closer
b. Secondary Intention=woud left open to granulate closed itself (burns,infections, wounds that popped open)
c. Delayed Primary or Tertiary intention= combines 1st and secondary intentions, for wounds that need washing out, oxygenation, or tissue tensions to reduce the closer.

Question 8

hyperytrophic scar

Answer 8

is that fucked up ear which happens more in dark skinned people on the face neck or torso

Question 9

Keloid

Answer 9

is excess growth of scar tissue at the site of healed skin injury.

Question 10

11) 4 types of chronic wounds

Answer 10

i. Decubitus (pressure) ulcers
ii. Venous insufficiency ulcers
iii. Arterial vascular disease
iv. Diabetic ulcers

Question 11

Neurologic illness a risk factor?

Answer 11

Decubitus Ulcers

15-30% nursing home pts have Decubitus Ulcers

Question 12

Irreversible tissue changes happen as quickly as?

Answer 12

2 hours of immobility and tissue pressure

Question 13

Decubitus Ulceration stages

Answer 13

i. Stage I = persistent skin erythema without skin breakdown, possibly reversible with no pressure x24 hours, may be irreversible and inevitable breakdown
ii. Stage II = partial thickness breakdown down to dermis
iii. Stage III = full thickness skin breakdown into subcutaneous tissue but not down to deep fascia
iv. Stage IV = breaks through fascia, bone, tendon, joint capsule may be involved, osteomyelitis may be present

Question 14

Venous stasis ulcers 
who?
where?
whats it look like?
what is etiology?
What are they not from?

Answer 14

chronic venous insufficiency, irregular borders

i. Women in 40yo, Men in 70yo
ii. Usually medial side of leg above ankle
iii. Skin looks shiny and taut with inflammation
iv. Can be from congenital absence of valves, stasis or injury, previous thrombi
v. NOT FROM VARICOSE VEINS

Question 15

15) Arterial vascular dz

Answer 15

atherosclerosis (not venous stais)leads to arterial insufficiency. Can cause chronic wounds or necrosis of the toes

i. Gangrene a real issue here, less of a border
ii. VERY painful

Question 16

Diabetic ulcers

etiology?

Answer 16

well circumscribed

etiology is dead tissue

Question 17

Def=Necrosis/Eschar

Answer 17

Black, brown or tan devitalized tissue that adheres to the wound bed or edges and may be firmer or softer than the surrounding skin.

Question 18

Slough

Answer 18

Soft, moist avascular tissue that adheres to the wound bed in strings or
thick clumps; may be white, yellow, tan or green.

Question 19

Granulation

Answer 19

• Pink/red moist tissue comprised of new blood vessels, collagen fibers
  and fibroblasts. Typically the surface is shiny and moist with a granular appearance.

Question 20

Epithelium

Answer 20

New pink and shin tissue/skin that grows in from the edges or as
islands on the wound surface.

Question 21

Induration

Answer 21

Abnormal hardening of the tissue caused by consolidation of edema,
this may be a sign of underlying infection

Question 22

Erythema

Answer 22

Redness of surrounding tissue may be normal in the inflammatory stage
of healing. However, if accompanied by an increase in temperature of tissue, exudates or pain may also be a sign of infection.

Question 23

Maceration

Answer 23

Caused by excessive moisture, Tissue loses its pigmentation (appears
lucid or turns white) and becomes soft and friable

Question 24

Exudate def= Serous

Purulent

Answer 24

thin, watery, clear or straw colored

thick, opaque, tan, yellow to green and may have an offensive odor

Question 25

Serosanguineous

Answer 25

thin, pale red to pink

Question 26

Wound Class I

Answer 26

Clean

a. Nontraumatic no inflammation
b. Resp, gastro, genito-urinary tracts not entered
c. Ex. Caesarean section, vascular proced

Question 27

Wound Class II

Answer 27

Clean Contaminated

a. nontraumatic wound with break in technique
b. resp, gastr o, genito-urinary enetered
c. ex. hysterectomy

Question 28

Wound Class III

Answer 28

Contaminated

a. traumatic from clean source, inflammation, spillage from intestinal tract, entrance into genito-urinary or biliary tract
b. when inf urine or bile present

Question 29

Wound Class IV

Answer 29

Dirty – Infected

a. traumatic with delayed tx
b. fecal contamination, foreign body
c. I&D abscess, wound debridement

Question 30

How to reduce surgical site infection rate?

Answer 30

a. Prophylactic antibiotics
b. Clippers for hair removal
c. Control sugar
d. Temp contol

Question 31

11) antibiotic frequency? If duration of procedure exceeds 1-2 times the bugs half life then give?

Answer 31

i. Cefazolin Every 2-5 hours
ii. Cefuroxime Every 3-4 hours
iii. Clindamycin Every 3-6 hours
iv. Vancomycin Every 6-12 hours

Question 32

12) S. aureus is carried in the nares of 20% to 30% of healthy humans

Answer 32

Patients undergoing cardiothoracic operations are recommended to preoperatively apply mupirocin to their nares.

Question 33

Organisms causing surgical site inf?

Answer 33

staph aureus, enterococcus