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Surgery > Wound Healing > Flashcards

Wound Healing Flashcards

1
Q

What are the four stages of wound healing? 4

A
  1. Hemostasis/Coagulation
  2. Inflammation
  3. Migration/Proliferation
  4. Remodeling
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2
Q

What are the components of the migration/proliferation phase in would healing? 4

A
  1. Angiogenesis
  2. Epithelization
  3. Contraction
  4. Fibroplasia
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3
Q

Coagulation

  1. Vessels rupture results in what?
  2. Platelet degranulate: release what? 2
  3. What are these? 7
  4. What kind of clot formation?
A
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4
Q

Thrombus formation includes? 3

A
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5
Q

The imflammation phase causes attraction/activation of infiltrating cells. What are these? 2

A
  1. Neutrophils
  2. Macrophages
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6
Q
  1. Neutrophils are not essential since what?
  2. Why are macrophages associated with wound healing? 2
A
  1. unless would contaminated

2.

  • Debridement/matrix turnover
  • major source of stimulatory signals
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7
Q

Role of macrophages in wound healing? 5

A
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8
Q

Describe the formation of vessels in angiogenesis of migration/proliferation?

4

A
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9
Q

Describe what goes on the the epithelization phase of migration/proliferaton? 4

A
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10
Q

Role of Keratinocytes in wound healing? 5

A
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11
Q
  1. During fibroplasia of migration/proliferation what is the function of the fibroblasts? 3
  2. Matric deposition dependant on what? 3
A
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12
Q

Role of fibroblasts in wound healing? 5

A
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13
Q

What is remodeling?

What are the the 3 steps in this?

A
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14
Q

Components of wound healing:

Describe the cell types in the following processes:

  1. Coagulation processes? 1
  2. Inflammatory Process? 3
  3. Migratory/proliferative process? 5
  4. Remodeling? 1
A
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15
Q

Describe which of the inflammatory mediators are active first and which are active last and how long each one stays active: 5

A
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16
Q

Healing retarded by several factors such as? 6

A
17
Q

Local factors affectig wound healing? 8

A
18
Q

Know your patient! Consider what things?7

A
  1. Age
  2. Nutritional Status
  3. Circulation
  4. Diabetes
  5. Smoking
  6. Steroids
  7. Support System
19
Q

Essential Nutrients for Wound Healing

8

A
  1. Calories
  2. Carbs
  3. Protein
  4. Fats
  5. Vitamin A
  6. Vitamin C
  7. Zinc
  8. Water
20
Q

Halsted’s Principles

What are Halsted’s principles? 6

A
  1. Gentle handling of tissues
  2. Careful hemostasis
  3. Aseptic technique
  4. Avoidance of tension
  5. Sharp dissection
  6. Obliteration of dead space
21
Q

What are our options for wound closure? 3

A
  1. Sutures
  2. Staples
  3. The V.A.C.
22
Q

Primary Intention:

  1. Wound closed with what? 2
  2. Covered w/ what?
  3. May drain a small amount of what? 2
  4. Generally kept protected from getting wet with a plastic cover for_____ depending on wound site,
  5. if allowed to get wet—whats our only option?
  6. Monitor for what? 4
A
  1. stitches or staples
  2. sterile dressing
  3. blood or serosanguinous fluid
  4. 2-10 days
  5. shower only, no bathtub or hot tub

6.

  • erythema,
  • swelling,
  • warmth
  • drainage
23
Q

For primary intention what might our note look like?

4

A
  1. Wound intact,
  2. no erythema or drainage,
  3. dressing dry,
  4. wound redressed.
24
Q

Secondary Intention:

  1. What are not closed, sometimes other layers not closed allowed to granulate in?
  2. Usually if there has been what? 3
  3. How should it be managed?
A
  1. 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
25
Q

The V.A.C. = Excellent results

Why? 3

A
  1. Decreases edema
  2. Enhances granulation and vascularity
  3. Lower bacterial counts
26
Q

Surgical Site Infections (SSI)‏

  1. Refers to what?
  2. What are the most common SSIs?
A
  1. Refers to infection at incision site, but also infections that extend to adjacent deeper structures
  2. 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

27
Q
  1. When are most SSIs acquired?
  2. Most common source is what?
  3. When a viscus is opened pathogens reflect flora from viscus and are usually what?
  4. More what are being isolated? 2
  5. Exogenous sources can occur from operating room personnel carrying what?
A
  1. Most SSIs are acquired at the time of surgery
  2. Most common source direct inoculation of pt flora— S. aureus and coag neg staph
  3. When a viscus is opened pathogens reflect flora from viscus and are usually polymicrobial
  4. More MRSA and candida are being isolated
  5. Exogenous sources can occur from operating room personnel carrying Group A strep
28
Q

Patient-Related Risk Factors for surgery

9

A
  1. DM
  2. Obesity
  3. Cigarette smoking
  4. Systemic corticosteroids or other immunosuppressive drugs
  5. Malnutrition
  6. Pre-op nasal carriage or colonization w/ S. aureus
  7. Presence of remote focus of infection
  8. Duration of preoperative hospitalization
  9. Preoperative severity of illness of patient
29
Q

Most Important Factors for Prevention of SSIs

3

A
  1. General health of the patient
  2. Meticulous operative techniques
  3. Timely administration of pre-op antibiotics
30
Q

Timely administration of pre-op antibiotics

  1. Given when?
  2. What do we give?
  3. For bowel procedures? 2
  4. If PCN allergy?
A
  1. Given within 60 min prior to surgical incision
  2. Cefazolin 1-2g IV preferred for most procedures
  3. For bowel procedures—cefoxitin or ampicillin/sulbactam
  4. Vancomycin if penicillin allergic
31
Q

Antibiotic Prophylaxis

Colorectal surgery

  1. Oral or IV?
  2. Oral regimen? 2
  3. Iv regimen? 2 options
A
  1. Can be oral, IV or both (Oral is equal to IV)
  2. Oral regimen is neomycin and erythromycin w/ bowel prep
  3. IV regimens:
    - Cefoxitin or cefotetan
    - Cefazolin + metranidazole
32
Q

What is tertiary intention?

A

Left open initially and then closed at a later time

Surgery (20 decks)

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