Wound Healing

Question 1

wound healing by primary intention

Answer 1

wound edges are closed w/ sutures, allowing very rapid coverage by epithelium and rapid wound healing

Question 2

how long should patients wait after major surgery before lifting any significant weight?

Answer 2

atleast 6 weeks

- wound is still producing collagen and cross-linking during this time

Question 3

patient feels a hard, knot-like structure beneath his skin in the area of his surgical wound

Answer 3

likely a surgical knot - wait for wound to completely heal, it will either resolve or it can be removed w/ local

Question 4

pt has a small, sore red area in his wound that intermittently drains a small amt of pus and then seals over…

Answer 4

stitch abscess - infection of a suture

- remove the suture under local

Question 5

pt has a 4 cm defect in the fascia (where his surgical wound used to be) and it bulges when he coughs

Answer 5

post-op ventral hernia due to fascial breakdown

Question 6

tx. for post-op ventral hernia

Answer 6

surgical repair

Question 7

pts scar post-op is red and sensitive to the touch still at 3 months

Answer 7

this is ok…complete wound remodelling and maturation may take up to 6 months

Question 8

pts wound scar is raised and hypertrophic in appearance

Answer 8

observation until the scar stabilizes; revision may be appropriate but recurrence is common unless the wound is treated with steroid injections and local pressure dressings

Question 9

keloid

Answer 9

scar that is raised and hypertrophic and spreading outside the immediate area of the incision

Question 10

on POD3 you note an area of redness and tenderness in the middle of the pts wound - what should you do?

Answer 10

suspect wound infection

• drain infection completely
• debride any non-viable tissue
• oral or IV antibiotics are not used

Question 11

healing by secondary intention

Answer 11

wounds that were contaminated at the initial surgery or left open by the surgeon or wounds that became infected and required opening in the immediate post-op period

Question 12

when can you use a split-thickness skin graft?

Answer 12

bacterial count on granulation bed must be < 10^5 bacteria/g of tissue; the graft is capable of revascularizing from granulation tissue (inosculation) and causing re-epithelialization of a wound that did not heal by primary intention

Question 13

when is collagen produced in a healing wound?

Answer 13

collagen production first detected at 10 hours and peaks in 5-7 days

Question 14

what growth factors are involved in wound healing?

Answer 14

1. PDGF - chemotactic for fibroblasts, neutrophils and macrophages
2. TGFB - increases collagen synthesis
3. FGF - hastens wound contraction
4. EGF - stimulates epithelial migration and mitosis (wound epitheliazation)

Question 15

appropriate management of a clean wound with low risk of infection (<2%)?

Answer 15

close wound w/ primary intention

no antibiotics needed perioperatively (unless mesh is inserted like in hernia repair)

Question 16

definition of “clean wound”

Answer 16

no entry is made into the GI, respiratory, genitourinary tracts and there is no active infection; less than 2% chance of infection

Question 17

definition of “clean-contaminated wound”

Answer 17

the GI, respiratory or genitourinary tract is entered but the tract is prepared both mechanically and antibacterialls; less than 3% chance of infection

Question 18

definition of “contaminated wound”

Answer 18

there is major contamination of the wound, such as gross spillage of stool from colon or infection in the biliary, respiratory or genitourinary tracts ex. bowel perforation; infection rate < 5%

Question 19

who should get prophylactic antibiotics preoperatively?

Answer 19

• brief, predictable exposure to bacteria
• implantation of device/prosthetic material
• impaired host defenses such as immunosuppression or poor blood supply

Question 20

what is the most effective way of administering perioperative antibiotics?

Answer 20

single dose 1 hr pre-op and single dose post-op