Wound healing

Question 1

Define abrasion

Answer 1

Loss of epidermis and some dermis

Question 2

Define avulsion

Answer 2

Tearing of tissues from attachments eg on the limbs, degloving

Question 3

Define incision

Answer 3

Created by sharp object with minimal trauma

Question 4

Define laceration

Answer 4

Tearing of wound creating irregular defect

Question 5

Define puncture

Answer 5

Penetrating wound: Superficial damage may be minimal, Deep damage may be substantial

Question 6

What are the three stages of wound healing?

Answer 6

The inflammatory phase
Vasoconstriction and then dilation as increased capillary permeability and platelet aggregation

The repair phase
Fibroblast migration and secretion of proteoglycans, collagen and elastin
Wound contraction and contact inhibition.

The remodelling phase
Maturation and cross linking of collagen. Increase in tensile strength.

Question 7

At 5 weeks the wound will be at …….% of its original strength

Answer 7

50%

Question 8

When assessing the type of wound what should we think about?

Answer 8

Degree of tissue damage
Depth of wound
Vital structures (bones, joints, nerves, tendons)
‘Tip of the iceberg’ (e.g. bite wounds)

Question 9

When assessing wound age what should we consider?

Answer 9

Are we within the GOLDEN PERIOD (6 - 8 hours) before wound is contaminated or infected

Question 10

When assessing the level of contamination what should we consider?

Answer 10

Foreign material
Bacterial inoculum (bite vs. clean glass)
When we initially see the wound to prevent further contamination we clip the hair (with KY jelly), debride the tissue, issue some antimicrobial therapy and think about closing it up.

Question 11

Why would we lavage a wound?

Answer 11

We can lavage wounds as a way of diluting the bacteria and encourage healing. Isotonic solutions are best (administer with a 20ml syringe and an 18G needle) – culture after the lavage.

Question 12

What factors will influence the golden period?

Answer 12

Vascular supply (reduced ability to fight infection)
Devitalised tissue (increased bacterial growth)
Type of contamination: soil better than organic debris, clean glass cut vs bite wound
Type of bacteria

Question 13

How can we do non-surgical debridement?

Answer 13

Use of wet to dry sterile swabs
Use of dry to dry swabs
Both act to draw away purulent and necrotic material

Question 14

What is primary closure oF a wound?

Answer 14

Immediate suture

Clean or clean-contaminated

Question 15

What is delayed primary closure?

Answer 15

Clean-contaminated to contaminated wounds
Reduces incidence of infection
Closure after 3-5 days

Question 16

What are the advantages and disadvantages of primary wound closure?

Answer 16

Advantages
o optimum wound drainage
o local infection control
o Cheap (?)

Disadvantages
o cosmetic results
o poor functional results
o time / expense

Question 17

What are passive drains and how do they work?

Answer 17

Penrose drain which is alatex rubber tube
gravity – place dependently and works by capillary action so needs large surface area
Do not exit wound directly
Always cover to reduce risk of ascending infection

Question 18

When should you remove a drain?

Answer 18

Drain removal should be as soon as possible as all drains produce an FB reaction and hence produce fluid, usually removed in 1-5 days

Question 19

What is the natural progression of a would from necrotic to epithelialisation?

Answer 19

Necrotic –> sloughy –> granulating –> epithelialising

Question 20

What is the ideal healing environment?

Answer 20

A moist environment - but not macerated
Free of infection and excessive debris
Free of toxic chemicals, particles or fibres
Warm - at the optimum temperature for healing
Leave new tissue undisturbed (minimise the frequency of dressing changes)
Allow for adequate gas exchange (oxygenation)
Dressing should be painless to apply & remove
Dressings should minimise contamination both to and from the wound

Question 21

What is alginate dressing and when is it useful?

Answer 21

Made from seaweed, alginate dressings are available as sterile pads, ribbons, or ropes. These non-occlusive dressings are non-adherent and promote autolytic debridement to soften and remove necrotic tissue. Stimulates granulation tissue

Question 22

What are foam dressings and when are they useful?

Answer 22

Foam dressings are absorbent, sponge-like polymer dressings. In addition to providing thermal insulation, they help create a moist wound environment.

Question 23

What are would fillers and when are they useful?

Answer 23

Used to fill deep wounds, some wound fillers add moisture to the wound bed whereas others absorb drainage. Made of various materials, wound fillers are available as pastes, granules, strands, powders, beads, and gels.

Question 24

What are contact layer dressings and when are they useful?

Answer 24

Made with a water or glycerin base, hydrogel dressings hydrate wounds and soften necrotic tissue. Because they contain a large percentage of water, these dressings provide limited absorption. Hydrogel dressings are available as a flexible sheet or a gel. Although hydrogel dressings are good for hydrating wounds, they must be used with care as they can also macerate the surrounding skin

Question 25

When are antimicrobial dressings useful?

Answer 25

Although hydrogel dressings are good for hydrating wounds, they must be used with care as they can also macerate the surrounding skin.
Covidien Antimicrobial Dressings (AMD) contain polyhexamethylene biguanide (PHMB) which binds/disrupts phospholipid outer membrane causing cell death – effective against MRSA, gram +ve, gram -ve Inc. Pseudomonas spp.

Question 26

The honey needs a manuka factor of what to be effective as an antibacterial?

Answer 26

+12

The osmotic action of the honey draws fluid out but the antibacterial activity prevents bacterial growth.

Question 27

Why does honey have debridement properties?

Answer 27

Honey also has good debridement properties due to its low pH (approx. 3.7) which helps to draw up fluid from the wound area and may be an alternative to hydrogels where infection is an issue.

Question 28

How can maggots be used in wound healing?

Answer 28

Stage 1 larvae only eat liquid protein so provide accurate and efficient debridement

Question 29

What is Silver sulphadiazine used for?

Answer 29

Excellent antibacterial and antifungal activity with no known resistance
Effective against gram negative organisms for example Pseudomonas spp
Effective against MRSA

Question 30

What are walking sutures used for?

Answer 30

Walking sutures are used after skin has been undermined as a method of distributing skin tension. The skin is pulled forward in increments so there is a cumulative effect of multiple walking sutures paced in rows not more than 2-3cm apart. The skin dimples eventually disappear and circulatory compromise and pockets of serosa need to be managed

Question 31

What are relaxin incisions?

Answer 31

Relaxing incisions are cuts made parallel to the wound to undermine the bipedicle flap
Can use two large relaxing incisions either side of the wound
Multiple relaxing incisions can also be made, they are staggered and provide not as much advancement as the single incision, they also increase risk of circulatory compromise.

Question 32

What are the two types of tissue flap? What are their pros/cons?

Answer 32

Vascularised
Resistance to infection, any tissue bed, may withstand radiation therapy, rapid healing (single procedure)

Non-vascularised
technically relatively simple, covers large tissue defects, requires vascular tissue bed, poor resistance to infection or radiation

Question 33

What are pinch grafts?

Answer 33

A small punched hole of granulated tissue is taken out and a section of healthy tissue is inserted