Wound Healing

Question 1

4 stages of wound healing

Answer 1

hemostasis
inflammation
proliferation
remodeling

Question 2

Healing by primary vs secondary vs third intention

Answer 2

primary - wound is closed via sutures/staples = rapid reepitheliazation = minimal scar formation
second - wound left open and granulation tissue forms = greater scar formation and wound contraction, bigger and heavier scar
third - delayed primary closure = less pronounced scar

Question 3

What things can interfere with wound healing?

Answer 3

infection
ischemia
poor nutritional status
poor blood flow/oxygenation
diabetes
smoking
uremia
immunosupression
obesity

Question 4

When can you resume heavy lifting after ex lap procedure typically

Answer 4

6 weeks generally

Question 5

3 months post op there is a…
…knot structure beneath skin?
….red area draining pus?
….4 cm defect in fascia that bulges on coughing?

Answer 5

knot = likely a suture knot, can be observed or removed under local anesthesia
red area draining pus = suture abscess, explore under local anesthesia and remove suture
bulging = likely a hernia which would suggest wound dehiscence…needs to be repaired surgically to prevent incarceration

Question 6

3 months post op…
…red sensitive scar (non draining)
…scar is raised and hypertrophic (WITHIN wound margin)
…scar is raised and hypertrophic (EXTENDING OUT wound margin)

Answer 6

red sensitive - post inflammatory phase of wound healing, reassure
raised hypertrophic within margin - hypertrophic scar, warrants observation…can do revision or treat with steroid injections and local pressure dressings
raised hypertrophic out of margin - keloid, same treatment as previous

Question 7

How long does wound maturation and remodeling continue to occur post op?

Answer 7

at least 6 months

Question 8

First signs of post op wound infection?

Answer 8

usualy day 3-5, redness and tenderness in middle of wound

Question 9

What to do if suspect post op wound infection?

Answer 9

control the source!!! diagnose with clinical eval, imaging, percutaneous drainiage, or surgical exploration
2 most important steps is DRAIN COMPLETELY and DEBRIDE NONVIABLE TISSUE

Question 10

What not to do first if suspect post op wound infection?

Answer 10

ORAL OR IV antibiotics! most wound infections don’t need them…unless cellulitis spreads despite adequate draininage and debridement

Question 11

Options for managing wound infection post drainage and debridement?

Answer 11

if healthy wound edges and no exudate…can watch and wait, treating with local wound care but that takes long as it heals by secondary intention

• you can also put skin thickness graft (make sure wound is clear of as much bacteria as possible and don’t injure site)…good for resolving wound problems
• can re-close wound with sutures to heal by third intention

Question 12

Who needs prophylalctic antibiotics?

Answer 12

Patients getting procedures involving brief predictable expose to bacteria (clean contaminated), implantation of device or prosthetic material (mesh), impaired host defense or immunosupression, or poor blood supply

Question 13

Who doesn’t need prophylactic antibiotic?

Answer 13

clean surgical procedures that don’t involve implantation of permanent foreign body

Question 14

How to describe surgical wound?

Answer 14

clean - no inflammation or interferance with respiratory, GI, genital or urinary tract
clean/contaminated - brief exposure to resp, GI, or urinary tract under conrolled conditions (elective colectomy)
contaminated - open, fresh, or accidental owunds, operations with breaks in sterile technique, nonpurulent infammation
dirty - wounds from trauma that have been open for days since injury, perforated viscera