Wound Healing and Management Flashcards
What are the types of wounds?
incision abrasion puncture avulsion laceration
What is the definition of an incision?
cut or wound intentionally produced by cutting w/ a sharp instrument
CLEAN
What is convenient about an incision wound?
has wound healing in mind, straight line
What is the definition of an avulsion?
wound where skin is torn partially or fully away, tends to bleed
What do you do with a partial avulsion?
debride and suture in place if viable
What do you do with a total avulsion?
generally not replaceable, can use as a skin graft if you remove fat
What is an additional negative about an avulsion?
cannot get back together; requires skin flap
What is the definition of a puncture?
wound or hole in the skin and deeper tissue layers cause by a sharp object
What do you not do with a puncture wound?
close it
How do you treat a puncture?
assessing damage to underlying vital structures, and examining for foreign body
What are examples of puncture wounds?
dog or cat bites, nails, or sharp metal
What is the definition of an abrasion?
superficial loss of the epithelial layer
What is required with an abrasion?
cleaning the wound, prevents traumatic tatooing
What may be required for cleaning of an abrasion?
pain medication or anesthesia
How do you treat an abrasion?
after cleaning give abx ointment, remaining cells will regenerate and migrate to close the wound
What is the definition of a laceration?
wound caused by a sharp object producing edges that may be jagged, dirty or bleeding
What can be effected by a laceration?
most often the skin, but any tissue can be affected (sub cut fat, tendon, muscle, bone)
What is the definition of a crush wound?
a body part that is subject to a high degree of pressure or force, usually after being squeezed between two heavy or immobile objects
What injuries are associated with crush wounds?
lacerations, fractures, compartment syndrome, bruising
What is a contusion?
area of soft tissue swelling and hemorrhage with out violation of the skin
How do you treat a contusion?
application of cold compress to minimize swelling, followed by application of warm, moist compress for absorption of blood
may need to evacuate the hematoma w/aspiration
What is a fact about the quantity of pressure ulcer in a patient?
if you have one you have more
What is a stage 1 pressure ulcer?
intact skin with non-blanchable redness of a localized area usually over a bony prominence, darkly pigmented skin may not have visable blanching; its color may differ from the surrounding area
What is a stage 2 pressure ulcer?
partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, with out slough; may also present as an intact open/ruptured serum filled blister
What is a stage 3 pressure ulcer?
a full thickness tissue loss; subcutaneous fat may be visable but bone, tendon and muscle are not exposed
slough may be present but does not obscure the depth of tissue loss
may include underminning or tunneling
How do you treat a stage 3 pressure ulcer?
clean very well and serial debride
What is a stage 4 pressure ulcer?
full thickness tissue loss with exposed bone, tendon or muscle
slough or eschar may be present on some parts of the wound bed
often includes tunneling or undermionning
What is an unstageable pressure ulcer?
full thickness tissue loss in which the base of the ulcer is covered by slough(yellow, tan, green, gray or brown) and/or eschar (tan, black, brown) in wound bed
What are the phases of healing?
substrate
proliferation
maturation
What is the substrate phase?
aka inflammatory, lag or exudative phase
PMNs quickly appear and remain approx 48 hrs and may be the origin of inflammatory mediators such as compliment and kallikrein
Monocytes enter the wound 24 hr after PMNs and evolve to macrophages
What are involved in the subsrate phase?
PMNs and macrophages
What are the main cells involved in wound debridement?
Macrophages
What do macrophages produce?
growth factors such as TGF-B (stimulates fibroblasts) , interleukin-1 (induces fever, promotes hemostasis, enhances fibroblast, and active T-cells)
What is the proliferative phase?
Characterized by the production of collagen; wound scar may be hard, red, raised
How is the wound inbetween the substrate phase and the proliferative?
edematous (tumor) and erythmatous (rubor); difficult to distinguish early signs of infection
What is the primary cell of the proliferative phase? What does it do?
fibroblast, produces collagen
What is the maturation phase?
remodeling phase, characterized by the maturation of collagen
wound scar gradually flattens and becomes less prominent, more pale and supple
What happens to the skin after a wound?
it will never reach the same strength (70%)
What are factors that affect healing?
amount of tissue trauma (laceration vs crush) hematoma bacterial contamination steroids nutritional status
What is the biggest reason why wounds breakdown?
poor nutrition
What are types of wound closures?
primary
secondary
tertiary or delayed primary
How do you do primary closure?
close by direct approximation of the wound edges. Includes primary suturing, stapling, gluing, pedicled flaps, and skingrafts
What does the wound like in primary closure?
wound is pink and tissue is fragile
What is the goal of primary closure?
to protect and promote new growth by maintaining a moist environment
What type of dressing do you use for a primary closure?
a low or adherent dressing, fragile skin
What do you use to irrigate all the wound closures?
0.9% sodium chloride
How do you do a secondary closure?
aka spontaneous closure
wound is left open and allowed to heal by process of wound contraction and epithelialization at a rate of 1 mm/day
When is secondary closure used?
wounds that have been infected or packed up
What is an example of a time where you would do a secondary closure?
ileostomy takedown
What is a bad sign in a secondary closure (or any closure really)?
if the wound is pale
What is going on in the wound in a secondary closure?
the inflammatory phase is continuing, producing granulation tissue “pound flesh” which consists of inflammatory cells and a proliferation of capillaries
What does the wound look like in a secondary closure?
granular in appearance, glossy red and bleeds easily; beefy and irritated
What is slough?
the formation of viscous, yellowish layer of tissue
What do you put over the wound in a secondary closure?
wet to dry dressing changes, VAC dressings or hyrocolloid
What can you add to the closure with the dressing?
collagenase(accuzyme)
What is VAC? What is it used for?
vacuum assisted closure
used for healing acute wounds and chronic wounds
uses continuous negative pressure distributed over wound surface
What are the last steps in secondary closure?
excise all granulation tissue and preform a delayed primary tertiary closure allowing the wound to heal by secondary intention. Then close with a skin graft
What is healing by tertiary closure?
delayed primary closure
wound is left open and later closed with suture
suturing interrupts secondary healing
When do you used tertiary closure?
grossly contaminated wounds
What are the steps in wound care?
sterile preparation and drapping admin of local anesthetic irrigation and debridement hemostasis closure in layers dressings and bandages
What are the steps of wound debridement and irrigation?
use sharp debridement to remove clot, debris, and necrotic tissue
irrigate w/ copious NS
evacuate hematomas
hemostasis achieved w/cauterization, absorbable ligature or pressure
What is a contraindication to cauterization? Why?
Venous bleeding, its controlled by pressure
