Wound Healing Flashcards
What are the four stages of wound healing? 4
- Hemostasis/Coagulation
- Inflammation
- Migration/Proliferation
- Remodeling
What are the components of the migration/proliferation phase in would healing? 4
- Angiogenesis
- Epithelization
- Contraction
- Fibroplasia
Coagulation
- Vessels rupture results in what?
- Platelet degranulate: release what? 2
- What are these? 7
- What kind of clot formation?
Thrombus formation includes? 3
The imflammation phase causes attraction/activation of infiltrating cells. What are these? 2
- Neutrophils
- Macrophages
- Neutrophils are not essential since what?
- Why are macrophages associated with wound healing? 2
- unless would contaminated
2.
- Debridement/matrix turnover
- major source of stimulatory signals
Role of macrophages in wound healing? 5
Describe the formation of vessels in angiogenesis of migration/proliferation?
4
Describe what goes on the the epithelization phase of migration/proliferaton? 4
Role of Keratinocytes in wound healing? 5
- During fibroplasia of migration/proliferation what is the function of the fibroblasts? 3
- Matric deposition dependant on what? 3
Role of fibroblasts in wound healing? 5
What is remodeling?
What are the the 3 steps in this?
Components of wound healing:
Describe the cell types in the following processes:
- Coagulation processes? 1
- Inflammatory Process? 3
- Migratory/proliferative process? 5
- Remodeling? 1
Describe which of the inflammatory mediators are active first and which are active last and how long each one stays active: 5
Healing retarded by several factors such as? 6
Local factors affectig wound healing? 8
Know your patient! Consider what things?7
- Age
- Nutritional Status
- Circulation
- Diabetes
- Smoking
- Steroids
- Support System
Essential Nutrients for Wound Healing
8
- Calories
- Carbs
- Protein
- Fats
- Vitamin A
- Vitamin C
- Zinc
- Water
Halsted’s Principles
What are Halsted’s principles? 6
- Gentle handling of tissues
- Careful hemostasis
- Aseptic technique
- Avoidance of tension
- Sharp dissection
- Obliteration of dead space
What are our options for wound closure? 3
- Sutures
- Staples
- The V.A.C.
Primary Intention:
- Wound closed with what? 2
- Covered w/ what?
- May drain a small amount of what? 2
- Generally kept protected from getting wet with a plastic cover for_____ depending on wound site,
- if allowed to get wet—whats our only option?
- Monitor for what? 4
- stitches or staples
- sterile dressing
- blood or serosanguinous fluid
- 2-10 days
- shower only, no bathtub or hot tub
6.
- erythema,
- swelling,
- warmth
- drainage
For primary intention what might our note look like?
4
- Wound intact,
- no erythema or drainage,
- dressing dry,
- wound redressed.
Secondary Intention:
- What are not closed, sometimes other layers not closed allowed to granulate in?
- Usually if there has been what? 3
- How should it be managed?
- Epidermis and dermis
2.
- contamination,
- an infected wound,
- peritonitis
3. Has to be packed daily to every other day w/ saline moistened gauze or sponges and covered w/ a sterile dressing
The V.A.C. = Excellent results
Why? 3
- Decreases edema
- Enhances granulation and vascularity
- Lower bacterial counts
Surgical Site Infections (SSI)
- Refers to what?
- What are the most common SSIs?
- Refers to infection at incision site, but also infections that extend to adjacent deeper structures
- Among surgical pts SSIs most common nosocomial infection (accounting for 38% of nosocomial infections)
Death is directly related to SSI in over 75% pts w/ SSI who die in the postop period
- When are most SSIs acquired?
- Most common source is what?
- When a viscus is opened pathogens reflect flora from viscus and are usually what?
- More what are being isolated? 2
- Exogenous sources can occur from operating room personnel carrying what?
- Most SSIs are acquired at the time of surgery
- Most common source direct inoculation of pt flora— S. aureus and coag neg staph
- When a viscus is opened pathogens reflect flora from viscus and are usually polymicrobial
- More MRSA and candida are being isolated
- Exogenous sources can occur from operating room personnel carrying Group A strep
Patient-Related Risk Factors for surgery
9
- DM
- Obesity
- Cigarette smoking
- Systemic corticosteroids or other immunosuppressive drugs
- Malnutrition
- Pre-op nasal carriage or colonization w/ S. aureus
- Presence of remote focus of infection
- Duration of preoperative hospitalization
- Preoperative severity of illness of patient
Most Important Factors for Prevention of SSIs
3
- General health of the patient
- Meticulous operative techniques
- Timely administration of pre-op antibiotics
Timely administration of pre-op antibiotics
- Given when?
- What do we give?
- For bowel procedures? 2
- If PCN allergy?
- Given within 60 min prior to surgical incision
- Cefazolin 1-2g IV preferred for most procedures
- For bowel procedures—cefoxitin or ampicillin/sulbactam
- Vancomycin if penicillin allergic
Antibiotic Prophylaxis
Colorectal surgery
- Oral or IV?
- Oral regimen? 2
- Iv regimen? 2 options
- Can be oral, IV or both (Oral is equal to IV)
- Oral regimen is neomycin and erythromycin w/ bowel prep
- IV regimens:
- Cefoxitin or cefotetan
- Cefazolin + metranidazole
What is tertiary intention?
Left open initially and then closed at a later time
