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Medicine II: Surgery > Wound Healing and Management > Flashcards

Wound Healing and Management Flashcards

1
Q

What are the types of wounds?

A 
incision
abrasion
puncture
avulsion
laceration
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2
Q

What is the definition of an incision?

A

cut or wound intentionally produced by cutting w/ a sharp instrument
CLEAN

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3
Q

What is convenient about an incision wound?

A

has wound healing in mind, straight line

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4
Q

What is the definition of an avulsion?

A

wound where skin is torn partially or fully away, tends to bleed

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5
Q

What do you do with a partial avulsion?

A

debride and suture in place if viable

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6
Q

What do you do with a total avulsion?

A

generally not replaceable, can use as a skin graft if you remove fat

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7
Q

What is an additional negative about an avulsion?

A

cannot get back together; requires skin flap

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8
Q

What is the definition of a puncture?

A

wound or hole in the skin and deeper tissue layers cause by a sharp object

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9
Q

What do you not do with a puncture wound?

A

close it

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10
Q

How do you treat a puncture?

A

assessing damage to underlying vital structures, and examining for foreign body

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11
Q

What are examples of puncture wounds?

A

dog or cat bites, nails, or sharp metal

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12
Q

What is the definition of an abrasion?

A

superficial loss of the epithelial layer

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13
Q

What is required with an abrasion?

A

cleaning the wound, prevents traumatic tatooing

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14
Q

What may be required for cleaning of an abrasion?

A

pain medication or anesthesia

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15
Q

How do you treat an abrasion?

A

after cleaning give abx ointment, remaining cells will regenerate and migrate to close the wound

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16
Q

What is the definition of a laceration?

A

wound caused by a sharp object producing edges that may be jagged, dirty or bleeding

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17
Q

What can be effected by a laceration?

A

most often the skin, but any tissue can be affected (sub cut fat, tendon, muscle, bone)

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18
Q

What is the definition of a crush wound?

A

a body part that is subject to a high degree of pressure or force, usually after being squeezed between two heavy or immobile objects

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19
Q

What injuries are associated with crush wounds?

A

lacerations, fractures, compartment syndrome, bruising

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20
Q

What is a contusion?

A

area of soft tissue swelling and hemorrhage with out violation of the skin

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21
Q

How do you treat a contusion?

A

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

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22
Q

What is a fact about the quantity of pressure ulcer in a patient?

A

if you have one you have more

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23
Q

What is a stage 1 pressure ulcer?

A

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

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24
Q

What is a stage 2 pressure ulcer?

A

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

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25
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
26
How do you treat a stage 3 pressure ulcer?
clean very well and serial debride
27
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
28
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
29
What are the phases of healing?
substrate proliferation maturation
30
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
31
What are involved in the subsrate phase?
PMNs and macrophages
32
What are the main cells involved in wound debridement?
Macrophages
33
What do macrophages produce?
growth factors such as TGF-B (stimulates fibroblasts) , interleukin-1 (induces fever, promotes hemostasis, enhances fibroblast, and active T-cells)
34
What is the proliferative phase?
Characterized by the production of collagen; wound scar may be hard, red, raised
35
How is the wound inbetween the substrate phase and the proliferative?
edematous (tumor) and erythmatous (rubor); difficult to distinguish early signs of infection
36
What is the primary cell of the proliferative phase? What does it do?
fibroblast, produces collagen
37
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
38
What happens to the skin after a wound?
it will never reach the same strength (70%)
39
What are factors that affect healing?
``` amount of tissue trauma (laceration vs crush) hematoma bacterial contamination steroids nutritional status ```
40
What is the biggest reason why wounds breakdown?
poor nutrition
41
What are types of wound closures?
primary secondary tertiary or delayed primary
42
How do you do primary closure?
close by direct approximation of the wound edges. Includes primary suturing, stapling, gluing, pedicled flaps, and skingrafts
43
What does the wound like in primary closure?
wound is pink and tissue is fragile
44
What is the goal of primary closure?
to protect and promote new growth by maintaining a moist environment
45
What type of dressing do you use for a primary closure?
a low or adherent dressing, fragile skin
46
What do you use to irrigate all the wound closures?
0.9% sodium chloride
47
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
48
When is secondary closure used?
wounds that have been infected or packed up
49
What is an example of a time where you would do a secondary closure?
ileostomy takedown
50
What is a bad sign in a secondary closure (or any closure really)?
if the wound is pale
51
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
52
What does the wound look like in a secondary closure?
granular in appearance, glossy red and bleeds easily; beefy and irritated
53
What is slough?
the formation of viscous, yellowish layer of tissue
54
What do you put over the wound in a secondary closure?
wet to dry dressing changes, VAC dressings or hyrocolloid
55
What can you add to the closure with the dressing?
collagenase(accuzyme)
56
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
57
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
58
What is healing by tertiary closure?
delayed primary closure wound is left open and later closed with suture suturing interrupts secondary healing
59
When do you used tertiary closure?
grossly contaminated wounds
60
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 ```
61
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
62
What is a contraindication to cauterization? Why?
Venous bleeding, its controlled by pressure

Medicine II: Surgery (14 decks)

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