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Surgery > Wound Healing > Flashcards

Wound Healing Flashcards

1
Q

Why do we need to know about wound healing?

A

Common problems
Failure to treat will lead to morbidity, increased costs
Concepts relatively simple & can lead to good results

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2
Q

How to Understand Wounds

A

Phases of wound healing
Important factors in each phase
Understand factors that influence wound healing

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3
Q

4 Stages of Wound Healing

A

Hemostasis/Coagulation
Inflammation
Migration/Proliferation
Remodeling

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4
Q

Coagulation

A

Platelet aggregation
Degranulation of platelets
Fibrin clot formation

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5
Q

Inflammation

A

Attraction/activation of infiltrating cells
Neutrophils
Macrophages

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6
Q

Neutrophils in the Inflammation Process

A

Phagocytosis of bacteria & matrix

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7
Q

Macrophages in the Inflammation Process

A

Debridement/matrix turnover
Major source of stimulatory signals
Important for would healing

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8
Q

Define Angiogenesis

A

Formation of blood vessels

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9
Q

How does angiogenesis occur?

A

Begin as endothelial cell buds
Progress toward wound space (follows oxygen gradient)
Immature vessels differentiate into capillaries, arterioles, & venues
Macrophages & keratinocytes provide angiogenic stimuli

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10
Q

Describe Epithelization

A

Epidermal covering reconstituted from wound margin & hair follicle remnants

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11
Q

How does epithelization occur?

A

Keratinocytes migrate across wound
During & after migration, differentiation & stratification of neodermis occurs
Epithelization aided by moist environment

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12
Q

What happens to the fibroblasts in fibroplasia?

A

Migrate into wound site & replicate
Dominant cell type at wound edge
Synthesize & deposit collagen & proteoglycans

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13
Q

What is matrix deposition dependent on?

A

Oxygen & substrate availability

Growth factors

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14
Q

Define Remodeling

A

Changes in matrix composition over time

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15
Q

What is healing retarded by?

A 
Ischemia
Dry wound environment
Infection
Foreign bodies
Anti-inflammatory therapy
Nutritional deficiency
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16
Q

Local Factors Affecting Wound Healing

A 
Mechanical injury
Infection
Edema
Ischemia/necrotic tissue
Topical agents
Ionizing radiation
Low oxygen tension
Foreign bodies
17
Q

Things to Know About Your Patient that will Affect Wound Healing

A 
Age
Nutritional status
Circulation
DM
Smoking
Steroids
Support system
18
Q

Essential Nutrients for Wound Healing

A 
Calories
Carbs
Protein
Fats
Vitamin A
Vitamin C
Zinc
Water
19
Q

Halsted’s Principles of Wound Care

A 
Gentle handling of tissues
Careful hemostasis
Aseptic technique
Avoidance of tension
Sharp dissection
Obliteration of dead space
20
Q

3 Types of Wound Healing

A

Primary intention
Secondary intention
Third intention

21
Q

Primary Intention of Wound Healing

A

Wound closed with stitches or staples
Cover with sterile dressing
Keep protected from getting wet
Monitor for erythema, swelling, warmth, & drainage

22
Q

Secondary Intention of Wound Healing

A

Epidermis & dermis not closed
Usually due to contamination, an infected wound, or peritonitis
Packed daily with saline moistened gauze or sponges
Covered with sterile dressing

23
Q

Third Intention of Wound Healing

A

I&D
Observed 3-4 days
Closed

24
Q

Types of Wound Closure

A

Staples
Sutures
Wound Vac

25
Q

Purpose of the Wound Vac

A

Decreases edema
Enhances granulation & vascularity
Lower bacterial counts
Excellent results

26
Q

Define Surgical Site Infection

A

Infection at the incision site

May extend to adjacent deeper tissues

27
Q

Most Common Nosocomial Infection Among Surgical Patients

A

Surgical site infection

28
Q

Patient Risk Factors for Surgical Site Infection

A 
DM
Obesity
Cigarette smoking
Systemic corticosteroids or other immunosuppressive drugs
Malnutrition
Pre-op nasal carriage or colonization with S. aureus
Presence of remote focus of infection
Duration of preoperative hospitalization
Preoperative severity of illness
29
Q

Most Important Factors for Prevention of Surgical Site Infections

A

General health of patient
Meticulous operative techniques
Timely administration of pre-op antibiotics

30
Q

IV Antibiotic Prophylaxis Regimen for Colorectal Surgery

A

Cefoxitin or cefotetan

Cefazolin + metronidazole

31
Q

Hair Removal and Surgical Site Infections

A

Due immediately prior to surgical incision

Surgery (20 decks)

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