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ENDO > Wound healing > Flashcards

Wound healing Flashcards

1
Q

What are the different classification of wounds?

A
  • Laceration=tearing of wound, irregular
  • Abrasion=loss of epidermis and some dermis
  • Incision= Minimal trauma as caused by sharp object
  • Avulsion=tearing of tissues from attachments (degloving)
  • Puncture= penetrative, can be superficial or deep
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2
Q

What is the subdermal plexus?

A
  • Contains the direct cutaneous artery.
  • Can use the plexus to keep skin flaps alive if there is a direct feed to the area of skin (can remove and rotate flaps so long as you keep the subdermal plexus attachment intact)
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3
Q

What are the phases of wound healing?

A
  • Haemostasis/ inflammation
  • Proliferation (repair phase)
  • Maturation (remodelling phase)
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4
Q

Describe the inflammatory phase

A
  • Vasoconstriction to stop bleeding
  • Vasodilation to increase capillary permeability
  • Activation of the clotting cascade and chemotaxis of inflammatory cells
  • Reduce bacterial contamination and help clotting.
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5
Q

Describe the repair phase

A
  • Fibroplasia
  • Fibroblasts migrate to area and try to bridge the damage
  • Contact inhibition: fibroblasts don’t stack directly on top of one another
  • The fibroblasts secrete proteoglycans, collagen and elastin to help reinforce the wound.
  • Wound starts to contract
  • Epithelialisation occurs
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6
Q

Describe the remodelling phase

A
  • Matrix is remodelled
  • Cross linking of collagen
  • Increases tensile strength
  • Can take weeks to months
  • BUT wound will never regain original strength
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7
Q

List factors affecting wound healing

A
  • Age
  • Nutrition
  • Medication (steroids)
  • Radiation
  • Co-morbidities (cushings/ diabetes)
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8
Q

What is the golden period?

A
  • 6-8 hours

- The period of time where a wound is a ‘contaminated’ wound. If it is older than 8 hours then it is an INFECTED wound

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9
Q

What do you use to get the correct pressure during lavage of a wound?

A
  • 18G needle and a 20ml syringe

- Gives 7-8 psi

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10
Q

What are the three different intentions in wound management?

A

-Primary= surgical closure of the wound
-Secondary=We leave the wound to heal itself
Tertiary= Do something to the wound to help clean it up and then surgically close it a few days later.

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11
Q

What can influence bacterial contamination?

A
  • Vascular supply
  • Presence of necrotic tissue
  • Type of contamination
  • Type of bacteria
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12
Q

Which solutions are best to lavage a wound?

A

Isotonic (e.g. saline or hartmanns)

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13
Q

Give examples of non surgical debridement

A

-Dressings:

wet-dry and dry-dry

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14
Q

What is a wet-dry dressing?

A
  • Sterile swab which is moistened with isotonic fluid
  • Place damp swab on wound
  • Place dry swabs on top
  • Helps create a nice granulation bed
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15
Q

When would you use a tie over bolus?

A

-When wound is in an area difficult to dress

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16
Q

Describe delayed primary closure of a wound

A
  • Used in clean-contaminated to contaminated wounds

- Use methods such as wet-dry dressing then close wound after 3-5 days

17
Q

What are the advantages and disadvantages of secondary intention healing?

A
  • Advantages: optimum wound drainage, local infection control
  • Disadvantages: cosmetic results, time/ expensive
18
Q

What is proud flesh?

A

Granulation tissue that has become unhealthy = preventing wound from healing, the epithelium cannot close over the top of it.
-Occurs during secondary intention healing

19
Q

What are the 2 types of drains?

A

Active and passive

20
Q

Describe passive drains

A
  • Penrose drain
  • Uses gravity
  • Has a wicking action to draw fluid out of the wound
  • Needs a large SA
21
Q

Describe active suction drains

A
  • Closed system that uses negative pressure to draw fluid out
  • More expensive than passive drains
  • Needs reactivating to keep negative pressure applied
22
Q

When should you remove a drain?

A

As soon as possible

Usually 1-5 days

23
Q

What is topical negative pressure?

A

A device that applies negative pressure via suction onto an open wound

  • Draws off fluid this reducing oedema in surrounding tissues
  • Reduces bacteria
  • Promotes healthy granulation
  • Aids epithelialisation
  • Increases wound perfusion
24
Q

What does wound healing continuum mean?

A

-A colour chart that helps you identify what stage of healing the wound is at

25
Q

What are alginate dressings?

A
  • Made from seaweed
  • Is a debriding dressing
  • Stimulate granulation tissue
26
Q

Describe foam dressings

A
  • Absorbent, sponge like dressing

- REMOVE excess fluid from wound during SLOUGHY stage

27
Q

Describe hydrogel dressings

A
  • Hydrate wounds and soften necrotic tissue
  • NOT debriding dressings
  • Useful at granulation/ epithelialisation stages
28
Q

Discuss the use of honey in wound healing

A
  • Has antimicrobial properties: manuka factor
  • Good debriding agent due to low pH
  • Osmotic action of honey pulls water out of the wound- NOT goo during epithelialisation
29
Q

Discuss the uses of silver sulphadiazine in wound healing

A
  • Antibacterial/ antifungal
  • Effective against gram neg (Pseudomonas spp)
  • Effective against MRSA
30
Q

What antibacterial agent is effective against MRSA?

A

Silver sulphadiazine

31
Q

List wound closure options

A
  • Walking sutures
  • Local flaps
  • Skin grafts
  • Axial pattern flaps
32
Q

What are langer lines?

A

-The skin has its own tension lines in it: areas where skin is more/ less mobile and tense

33
Q

When are walking sutures used?

A
  • After skin has been undermined

- Way of distributing skin tension

34
Q

What is a relaxing incision?

A

-An incision made parallel to the wound, allows movement of the wound

35
Q

What are the 2 types of skin flaps?

A

-Vascularised and non vascularised

36
Q

Where are the terminal branches of the direct cutaneous arteries located?

A
  • Subdermal plexus

- Within panniculus and subcutis

37
Q

What are the complications that can arise with skin flaps?

A
  • Partial/ full thickness necrosis

- Desensitisation leading to self trauma

38
Q

What are punch/ pinch grafts?

A
  • Non vascularised grafts

- Use small areas of tissue and place them onto area you want epithelium to develop- used to seed epithelium

ENDO (39 decks)

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