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Surgery I > Wound Healing and Wound Management > Flashcards

Wound Healing and Wound Management Flashcards

1
Q

First to differentiate diseased and infected wounds from non-infected wounds

A

Egyptians

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2
Q

Relates use of mixtures containing homey, lint and grease for treating wounds

A

Ebers’s Papyrus

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3
Q

Describes at least 48 types of wounds

A

Edwin Smith Surgical Papyrus

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4
Q

Successful surgical case

A

Patient survives
Pathology is removed and/or corrected
Patient’s wound heals

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5
Q

Employed 2 types of treatment (spiritual and physical method)

A

Sumerians

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6
Q

Dispelled the theory of spontaneous generation of germs

A

Louis Pasteur

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7
Q

Started soaking surgical instruments in phenol and spraying operating room

A

Joseph Lister

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8
Q

Classified wounds into acute or chronic

A

Greeks

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10
Q

Doctor of Roman gladiators

A

Galen of Pergamum

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10
Q

Emphasized the need of moist environment to ensure adequate healing

A

Galen of Pergamum

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11
Q

Production of antiseptic dressing - cotton gauze impregnated with iodoform

A

Robert Wood Johnson

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12
Q

Normal wound healing pattern

A
  1. Hemostasis and inflammation
  2. Proliferation
  3. Maturation and remodelling
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13
Q

Phase which begins immediately and ends within a few days

A

Inflammatory phase

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14
Q

Hungarian obstetrician who noted the incidence of puerperal fever was much lower if medical students washed their hands following cadaver dissection and prior to attending childbirth

A

Ignaz Phillipp Semmelweis

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15
Q

Capillary regression leads to a less vascularized wound

A

Remodeling phase

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16
Q

Precedes inflammation and initiates inflammation with the ensuing release of chemotactic factors from the wound site

A

Hemostasis

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17
Q

Wounding leads to (3)

A
  1. Division of blood vessel and direct exposure of ECM to platelets
  2. Direct exposure of subendothelial collagen to platelets
  3. Release of wound active sibstances through platelet alpha granules
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18
Q

Complex cellular and biochemical cascade that leads to restitution of integrity and function

A

Wound healing

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20
Q

Direct exposure of subendothelial collagen to platelets results to

A

Platelet aggregation, coagulation and activation of coagulation cascade

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21
Q

Deposition of the fibrin-fibrinogen matrix and collagen, resulting in formation of the wound matrix and an increase in wound strength

A

Proliferation phase

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22
Q

Serves as scaffolding for the migration into the wound of inflammatory cells

A

Fibrin clot

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23
Q

Peaks at 24 to 48 hiurs but most do not survive in >1 day

A

Polymorphonuclear neutrophils

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24
Q

Functions of inflammatory cells (2)

A
  1. Sterilize the ound

2. Secrete growth factors

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25
Q

Primary role of PMNs

A

Phagocytosis of bacteria and tissue debris

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26
Q

Disruption of tissue integrity

A

Wounding

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27
Q

Wound active substances include (4)

A 
PDGF
TGF-beta
Platelet-activating factor
Fibronectin
Serotonin
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28
Q

Achieve significant numbers in the wound by 48-96 hours post-injury

A

Macrophages

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29
Q

First to infiltrate wound site

A

Polymorphonuclear neutrophils

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30
Q

PMNs are stimulated by (7)

A 
Inc. vascular permeability
Release of local prostaglandins
Complement factors
IL-1
TNF-alpha
TFG, platelet factor 4
Bacterial products
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30
Q

Release proteases that participate in matrix and ground substance degradation in the early phase of wound healing

A

PMNs

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32
Q

Macrophages contribute to microbial stasis through (3)

A

Oxygen radical synthesis
Nitric oxide synthesis
Regulation of cell proliferation, matrix matrix synthesis and angiogenesis

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33
Q

Most pivotal function of macrophages

A

Activation and recruitment of other cells

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34
Q

Major source of cytokines early during inflammation which may have a significant influence on subsequent angiogenesis and collagen synthesis

A

PMNs

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35
Q

Less numerous than macrophages

A

T-lymphocytes

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36
Q

Do not appear to play a role in collagen deposition or acquisition of mechanical wound strength

A

PMNs

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37
Q

Remain present until wound healing is complete

A

Macrophages

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38
Q

Macrophages regulate cell proliferation, matrix synthesis and angiogenesis by releasing (5)

A 
TGF
VEGF
Insulin-like GF
Epithelial GF
Lactate
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39
Q

Depletion of most wound T lymphocytes lead to (2)

A

Decreased wound strength

Decreased collagen content

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40
Q

Exert a down-regulating effect on fibroblast collagen synthesis

A

T lymphocytes

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41
Q

T lymphocytes exert a down-regulating effect on fibroblast collagen synthesis by

A

Cell-associated interferon, TNF-alpha and IL-1

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42
Q

Macrophages activate and recruit other cells via (2)

A

Mediators such as cytokines and GFs

Directly by cell-cell interaction and ICAM

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43
Q

Peaks at 1 week post-injury

A

T-lymphocytes

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44
Q

Spans 4-12 days

A

Proliferative Phase

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45
Q

Last to infiltrate the healing wound

A

Fibroblast and endothelial cells

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46
Q

Strongest chemotactic factor for fibroblasts

A

PDGF

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47
Q

Selective depletion of the CD8+ suppressor subset of T lymphocytes leads to

A

Enhanced wound healing

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48
Q

Activation of fibroblasts

A

Cytokines and GFs released by wound healing

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49
Q

Potent regulator of collagen synthesis through a mechanism involving ADP-ribosylation

A

Lactate

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50
Q

Ridges transition from inflammatory to proliferative phase of healing

A

T-lymphocytes

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51
Q

Main function of fibroblasts

A

Matrix synthesis and remodelling

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52
Q

Re-establishment of tissue continuity

A

Proliferative Phase

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52
Q

Fibroblasts isolated from wound (3)

A

Synthesize more collagen than nonwound fibroblasts
Proliferate less
Carry out matrix contraction

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53
Q

Most abundant protein in the body

A

Collagen

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54
Q

Type of collagen which is the major component of ECM in skin

A

Type I

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55
Q

Migration, replication and new capillary tube formation are under the influence of (2)

A

Cytokines

Growth factors as TNF-a, TGF-b and VEGF

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56
Q

Collagen is secreted by

A

Fibroblasts

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57
Q

Release of protocollagen results in

A

Hydroxylation of proline to hydroxyproline and of lysine to hydroxylysine

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58
Q

Type of collagen normally present in skin, becomes more prominent and important during the repair process

A

Type III

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60
Q

Composition of collagen

A

Glycine (in every third position)
Proline
Proline/lysine (2nd position)

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61
Q

Contains nonhelical peptide domains at both ends

A

Procollagen

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62
Q

Cleaves the nonhelical registration peptides extracellularly

A

Procollagen peptidase

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62
Q

Comprise a large portion of the ground substance that makes up granulation tissue

A

Glycosaminoglycans

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63
Q

Prolyl hydroxylase requires (3)

A

Oxygen and iron as cofactors
Alpha ketoglutarate as cosubstrate
Ascorbic acid as an electron donor

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64
Q

Major glycosaminoglycans present in wounds

A

Dermatan and chondroitin sulfate

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65
Q

Nonhelical peptide domains at both ends of procollagen

A

Registration peptides

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66
Q

Entwined three alpha-helical chains and is a right-handed superhelical structure

A

Procollagen

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67
Q

Breaks down collagen during maturation and remodelling

A

Matrix metalloprotinases

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68
Q

Net wound collagen content is a result of a balance between

A

Collagenolysis and collagen synth sis

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69
Q

Comprise a large portion of the ground substance that makes up granulation tissue

A

Glycosaminoglycans

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70
Q

Glycosaminoglycans couple with protein to form

A

Proteoglycans

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71
Q

A class of metalloproteinases that require activation and is a result of collagenase activity

A

Collagenolysis

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72
Q

Major glycosaminoglycans present in wounds

A

Dermatan and chondroitin sulfate

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73
Q

Factors that affect both aspects of collagen remodeling

A

Inc. new collagen transcription
Dec. collagen breakdown
By stimulating synthesis of tissue inhibitors of metalloproteinase

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74
Q

Continues for months postinjury, resulting in a mature, avascular and acellular scar

A

Scar remodelling

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75
Q

Postulted as the major cell responsible for wound contraction

A

Myofibroblast

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76
Q

Begins during the fibroblastic phase and is characterized by reorganization of previously synthesized collagen

A

Maturation and remodelling

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77
Q

Glycosaminoglycans couple with protein to form

A

Proteoglycans

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78
Q

Characteristic pattern of deposition of matrix at wound site

A
  1. Fibronectin and collagen type III constitute the early matrix scaffolding
  2. Glycosaminoglycans and proteoglycans
  3. Collagen type I is the final matrix
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79
Q

Ultimate determinant of wound strength d integrity

A

Balance of collagen deposition and degradation

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80
Q

Undetectable until day 6 and then is increasingly expressed for the next 15 days of wound healing

A

Alpha smooth smooth muscle actin

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81
Q

Components of collagen

A

Hydroxyproline and hydroxylysine

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82
Q

Characterized primarily by proliferation and migration of epithelial cells adjacent to the wound

A

Epithlialization

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83
Q

Step of wound healing impaired by steroids and other immunosuppressants, congenital or acquired immune-deficient states

A

Inflammation

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84
Q

Begins during the fibroblastic phase and is characterized by reorganization of previously synthesized collagen

A

Maturation and remodelling

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85
Q

T/F: mechanical strength of the scar achieves that of the uninjured tissue after scar remodelling

A

False

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86
Q

T/F: the presence of granulation tissue is reassuring evidence that the healing process is under way

A

True

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87
Q

Step in wound healing impaired by anticoagulants, antiplatelet agents, and coagulation factor deficiency

A

Coagulation

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88
Q

Epithelialization of surgical wounds closed primarily is usually complete by

A

24-48 hours

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89
Q

Synthesis and hydroxylation of hydroxyproline and hydroxylysine are dependent on

A

Fe, alpha ketoglutarate and ascorbate

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90
Q

For a wound to be considered clean

A
  1. Wound created in a sterile and nontraumatic fashion, in an area that is free of preexisting inflammation
  2. The respiratory, alimentary, genital, or urinary tract was not entered
  3. All persons involved in the case maintained strict aseptic technique
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91
Q

Signs of inflammation

A

Pain, swelling, heat, erythema, loss of function

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92
Q

For a wound to be considered contaminated

A
  1. There was gross spillage from GIT
  2. Genitourinary and biliary tracts were entered in the presence of local infection
  3. Major break in aseptic technique
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93
Q

Wounds that heal in a predictable manner and time frame

A

Acute wounds

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94
Q

Gives granulation tissue its characteristic beefy red appearance

A

Angiogenesis

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95
Q

Wounds that have proceeded through the repair process without producing an adequate anatomic and functional result

A

Chronic wounds

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96
Q

Integrity of basement membrane is restored to which type of collagen during epithelialization

A

Type IV

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97
Q

In primary intention, wound strength reaches its maximum at about how many months and how many % that of normal skin?

A

3 months

70-80%

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98
Q

Gives myofibroblast contractile ability

A

Alpha smooth muscle actin in thick bundles

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99
Q

Occurs after wound repair has ceased and can lead to undesirable effects

A

Scar contracture

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100
Q

Reasons for not using sutures

A
  1. Wounds edges cannot be apposed because the defect is very large
  2. Surgeon chooses not to close the wound primarily because of high risk of infection
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101
Q

For a wound to be considered clean-contaminated

A

Respiratory, alimentary, genital or urinary tract was entered, but there was no significant spillage of its contents and there was no established local infection; minor break in aseptic technique

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102
Q

Consisting of the placement of sutures, allowing the wound to stay open for a few days, and the subsequent closure of sutures

A

Third intention

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103
Q

Majority of wounds that have not healed in 3 months

A

Chronic wounds

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104
Q

Wound healing characterized by decreased wound-breaking strength compared to normal

A

Delayed healing

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105
Q

Incised wound that is clean and closed by sutures

A

Primary (first) intention

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106
Q

Wound healing characterized by a constant and continual increase that reaches a plateau at some point postinjury

A

Normal healing

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107
Q

Wound healing characterized by a failure to achieve mechanical strength equivalent to normally healed wounds

A

Impaired healing

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108
Q

T/F: Superficial injury of the cartilage is fast to heal.

A

False

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109
Q

T/F: delayed healing eventually achieve the same integrity and strength as wounds that heal normally

A

True

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110
Q

Type of healing seen following closure of wounds that are not approximated with sutures

A

Second intention

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111
Q

For a wound to be considered dirty/infected

A
  1. The wound was the result of remote trauma and contains devitalized tissue and/or purulent material
  2. There is established infection or perforated viscera prior to the procedure
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112
Q

3 crucial steps in healing

A
  1. Survival of axonal bodies
  2. Regeneration of axons that grow across transected nerve to reach the distal stump
  3. Migration and connection of the regenerating nerve ends to the appropriate nerve ends or organ targets
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113
Q

Accumulation of blood at fracture site containing devitalized soft tissue, dead bone and necrotic marrow

A

Initial stage of hematoma formation

114
Q

Distinguishing feature of fetal wound healing

A

Lack of scar formation

115
Q

T/F: Hypovascular tendons tend to heal with less motion and more scar formation than tendons with better blood supply

A

True

116
Q

Effect of vitamin a deficiency in wound healing

A

Impaired fibroplasias, collagen synthesis, cross-linking and epithelialization

117
Q

Fibril formation and crosslinking results in

A

Dec. collagen solubility
Inc. strength
Inc. resistance to enzymatic degradation of collagen matrix

118
Q

Effect of corticosteroids in wound healin

A

Reduce wound inflammation, collagen synthesis and contraction

119
Q

Effect of diabetes mellitus in wound healing

A

Impair keratinocyte growth factor and platelet-derived growth factor functions in the wound

120
Q

T/F: degree of nutritional impairment need not be long standing in humans to affect wound healing

A

True

121
Q

Types of nerve injuries and definition

A
  1. Neurapraxia - focal demyelination
  2. Axonotmesis - interruption of axonal continuity but preservation of Schwann cell basal lamina
  3. Neurotemesis - complete transection
122
Q

T/F: supplemental vitamin a can reverse the inhibitory effects of corticosteroids on wound healing

A

True

123
Q

Phagocytic removal of degenerating axons and myelin sheath from distal stump

A

Wallerian degeneration

124
Q

Effects of zinc deficiency in wound healing

A

Dec. fibroblast proliferation, dec. collagen synthesis, impaired overall wound strength, delayed epithelialization

125
Q

Breaks down collagen during maturation and remodelling

A

Matrix metalloprotinases

126
Q

Net wound collagen content is a result of a balance between

A

Collagenolysis and collagen synth sis

127
Q

T/F: Immediate use of steroids postop does not affect wound healing severely

A

False

128
Q

Most common organisms responsible for wound infection (in order of frequency)

A
  1. Staphylococcus species
  2. Coagulase-negative streptococcus
  3. Enterococci
  4. Escherichia coli
129
Q

Most well-known element in wound healing

A

Zinc

130
Q

Definition of wound infection (3)

A
  1. All wounds draining pus, whether or not the bacteriologic studies are positive
  2. Wounds that are opened by the surgeon
  3. Wounds that the surgeon considers infected
131
Q

Basis of selection of antibiotics for use in prophylaxis (3)

A
  1. Type of surgery to be performed
  2. Operative contaminants that might be encountered during the procedure
  3. The profile of resistant organisms present at the institution where the surgery is performed
132
Q

Wound infection that involves skin and subcutaneous tissue only

A

Superficial incisional

133
Q

Most dangerous of the deep infections

A

Necrotizing fasciitis

134
Q

Differentiate contamination, colonization, infection

A

Contamination - presence of bacteria without multiplication
Colonization - multiplication without host response
Infection - presence of host response in reaction to deposition and multiplication of bacteria

135
Q

Effect of vitamin c deficiency in wound healing

A

Inadequate collagen production

136
Q

Organisms most commonly responsible for CGD (5)

A 
S. Aureus
Aspergillus
Klebsiella
Serratia
Candida
137
Q

Effect of vitamin b6 deficiency in wound healing

A

Impaired collagen cross-linking

138
Q

Factors affecting the level of vasoconstriction of the subcutaneous capillary bed

A

Fluid status, temperature, hyperactive sympathetic tone

139
Q

Major component of chronic wounds

A

Skin ulcers

140
Q

Used to diagnose CGD

A

Nitroblue tetrazolium reduction test

141
Q

T/F: mild to moderate normovolemic anemia does not appear to adversely affect wound oxygen tension and collagen synthesis unless the hematocrit falls below 10%

A

False (15%)

142
Q

Wound infection that arise immediately adjacent to fascia, either above or below it, and may often have an intraabdominal component

A

Deep incisional

143
Q

Ulcers that occur due to a lack of blood supply

A

Ischemic arterial ulcers

144
Q

An ulcer that fails to re-epithelialize despite the presence of adequate granulation tissue

A

Venous stasis ulcer

145
Q

Antibiotic prophylaxis is most effective when (2)

A
  1. Adequate concentrations of antibiotic are present in the tissues at the time of incision
  2. Adequate preoperative antibiotic dosing and timing
146
Q

Ischemic arterial ulcers are usually present at

A

Most distal portions of the extremities such as the interdigital clefts

147
Q

Most common site of stasis ulcer

A

Above the medial malleolus, over Cockett’s perforator

148
Q

Treatment of venous ulcers

A

Compression therapy

149
Q

Type of wound healing used following removal of ruptured appendix in which there is leakage of pus into the peritoneal cavity

A

Third intention

150
Q

Localized area of tissue necrosis that develops when soft tissue is compressed between a bony prominence and an external surface

A

Decubitus or pressure ulcers

151
Q

Effect of oxygenation in wound healing

A

Augment collagen synthesis

152
Q

Differentiate sensory neuropathy from motor neuropathy

A

Sensory - allows unrecognized injury to occur from ill-fitting shoes, foreign bodies, or other trauma
Motor (Charcot’s foot) - leads to collapse or dislocation of the interphalangeal or metatarsophalangeal joints, causing pressure on areas with little protection

153
Q

Ulcer which is a site of incompetent perforators

A

Stasis ulcers

154
Q

Malignant wounds are differentiated clinically from nonmalignant wounds by

A

Presence of overturned wound edges

155
Q

Infection of any anatomical structure remote from the incisional site but manipulated during the procedure

A

Organ/space surgical site infection

156
Q

Dose of contaminating microorganisms required to result in an increased risk of wound infection

A

10^5

157
Q

Type of healing seen following closure if wounds in which there is obvious gross contamination at the incisional site

A

Third (delayed primary) intention

158
Q

Poor operative techniques that may lead to wound failure

A

Suture material with inadequate tensile strength
Inadequate. Umber of sutures
Too small bite size

159
Q

Similarities of hypertrophic scars and keloids

A

Both occur after trauma to the skin and may be tender, pruritic and cause a burning sensation
Histologically - demonstrate increased thickness of the epidermis with absence of rete ridges, abundance of collagen and glycoprotein deposition

160
Q

Major contributors of diabetic ulcers

A

Neuropathy (60-70%) secondary to persistently elevated glucose
Foot deformity
Ischemia (15-20%)

161
Q

T/F: vitamin a have absolutely helps in normally healing wounds

A

False

162
Q

Four stages of pressure ulcer formation

A

Stage I - nonblanching erythema of intact skin
Stage II - partial-thickness skin loss involving epidermis or dermis or both
Stage III - full-thickness skin loss, but not through the fascia
Stage IV - full-thickness skin loss with extensive involvement of muscle and bone

163
Q

Removes pericellular transudate and wound exudate as well as deleterious enzymes

A

Negative pressure wound therapy

164
Q

Absorption characteristics of dressings

A

None - films
Low - hydrogels
Moderate - hydrocolloids
Hig - foams, alginates, collagen

165
Q

Genetically heterogeneous group of diseases in which the reduced NADPH-dependent oxide enzyme is deficient

A

Chronic granulomatous disease

166
Q

Characteristic pattern of deposition of matrix at wound site

A
  1. Fibronectin and collagen type III constitute the early matrix scaffolding
  2. Glycosaminoglycans and proteoglycans
  3. Collagen type I is the final matrix
167
Q

T/F: negative pressure wound therapy cannot be used in ischemic, badly infected or inadequately debrided wounds or in malignancy

A

True

168
Q

T/F: Wound dressing is contraindicated in infected and/or highly exudative wounds since it may enhance bacterial growth

A

True

169
Q

Early surgical site infections that occur in the first 24 hours postop are most commonly due to

A

streptococcus or clostridium

170
Q

Signs of infection to look for before administration of antibiotics

A

Erythema, cellulitis, swelling, purulent discharge

171
Q

Differentiate dehiscence and incisional hernia

A

Dehiscence - if wound failure occurs early in the postop course before all stages of wound healing have occurred
Incisional hernia - if months or years postop

172
Q

T/F: Occlusive and semiocclusive dressings are water-proof and impermeable to microbes, water vapor and oxygen

A

False

173
Q

Guidelines for wound dressing

A

If nondraining - semi-occlusive dressing
If drainage (<1-2 ml/d) - semi-occlusive or absorbent nonadherent dressing
If moderately draining (3-5 ml/d) - nonadherent primary layer plus as absorbent secondary layer plus an occlusive dressing to protect normal tissue
If heavily draining (>5 ml/d) - same as above with the addition of a highly absorbent secondary layer

174
Q

Tyoe of dressing designed to match the exudative properties of the wounds

A

Absorbent dressing

175
Q

T/F: epinephrine can be used in wounds of the fingers, toes, ears, nose or penis due to risk of tissue necrosis secondary to terminal arteriole vasospasm

A

False

176
Q

Basics of wound management

A 
Optimize systemic parameters
Debride nonviable tissue
Reduce wound bioburden
Optimize blood flow
Reduce edema
Use dressings appropriately
Use pharmacologic therapy
Close wounds with grafts/flaps as indicated
177
Q

Hypertrophic scars vs keloids

A

Hypertrophic scar - subside spontaneously, in areas under tension, formed along the incisional line

Keloids - spread beyond the margins of original wound and are painful, require treatment, around earlobes and the deltoid, presternal and upper back regions

178
Q

Commonly painless ulcer which results from incompetence of the deep venous system

A

Chronic venous ulcer

179
Q

Septic thrombosis of the vessels between the skin and the deep layers

A

Necrotizing fasciitis

180
Q

Fibril formation and crosslinking results in

A

Dec. collagen solubility
Inc. strength
Inc. resistance to enzymatic degradation of collagen matrix

181
Q

T/F: cancers arising de novo in chronic wounds include squamous cell carcinoma only

A

False (basal cell also)

182
Q

Continues for months postinjury, resulting in a mature, avascular and acellular scar

A

Scar remodelling

183
Q

T/F: mechanical strength of the scar achieves that of the uninjured tissue after scar remodelling

A

False

184
Q

A class of metalloproteinases that require activation and is a result of collagenase activity

A

Collagenolysis

185
Q

Factors that affect both aspects of collagen remodeling

A

Inc. new collagen transcription
Dec. collagen breakdown
By stimulating synthesis of tissue inhibitors of metalloproteinase

186
Q

Ultimate determinant of wound strength d integrity

A

Balance of collagen deposition and degradation

187
Q

Characterized primarily by proliferation and migration of epithelial cells adjacent to the wound

A

Epithlialization

188
Q

Postulted as the major cell responsible for wound contraction

A

Myofibroblast

189
Q

Gives myofibroblast contractile ability

A

Alpha smooth muscle actin in thick bundles

190
Q

Undetectable until day 6 and then is increasingly expressed for the next 15 days of wound healing

A

Alpha smooth smooth muscle actin

191
Q

Step in wound healing impaired by anticoagulants, antiplatelet agents, and coagulation factor deficiency

A

Coagulation

192
Q

Signs of inflammation

A

Pain, swelling, heat, erythema, loss of function

193
Q

Step of wound healing impaired by steroids and other immunosuppressants, congenital or acquired immune-deficient states

A

Inflammation

194
Q

Components of collagen

A

Hydroxyproline and hydroxylysine

195
Q

Synthesis and hydroxylation of hydroxyproline and hydroxylysine are dependent on

A

Fe, alpha ketoglutarate and ascorbate

196
Q

Gives granulation tissue its characteristic beefy red appearance

A

Angiogenesis

197
Q

T/F: the presence of granulation tissue is reassuring evidence that the healing process is under way

A

True

198
Q

Integrity of basement membrane is restored to which type of collagen during epithelialization

A

Type IV

199
Q

Epithelialization of surgical wounds closed primarily is usually complete by

A

24-48 hours

200
Q

Occurs after wound repair has ceased and can lead to undesirable effects

A

Scar contracture

201
Q

For a wound to be considered clean

A
  1. Wound created in a sterile and nontraumatic fashion, in an area that is free of preexisting inflammation
  2. The respiratory, alimentary, genital, or urinary tract was not entered
  3. All persons involved in the case maintained strict aseptic technique
202
Q

For a wound to be considered clean-contaminated

A

Respiratory, alimentary, genital or urinary tract was entered, but there was no significant spillage of its contents and there was no established local infection; minor break in aseptic technique

203
Q

For a wound to be considered contaminated

A
  1. There was gross spillage from GIT
  2. Genitourinary and biliary tracts were entered in the presence of local infection
  3. Major break in aseptic technique
204
Q

For a wound to be considered dirty/infected

A
  1. The wound was the result of remote trauma and contains devitalized tissue and/or purulent material
  2. There is established infection or perforated viscera prior to the procedure
205
Q

Wounds that heal in a predictable manner and time frame

A

Acute wounds

206
Q

Majority of wounds that have not healed in 3 months

A

Chronic wounds

207
Q

Wounds that have proceeded through the repair process without producing an adequate anatomic and functional result

A

Chronic wounds

208
Q

Incised wound that is clean and closed by sutures

A

Primary (first) intention

209
Q

In primary intention, wound strength reaches its maximum at about how many months and how many % that of normal skin?

A

3 months

70-80%

210
Q

Type of healing seen following closure of wounds that are not approximated with sutures

A

Second intention

211
Q

Reasons for not using sutures

A
  1. Wounds edges cannot be apposed because the defect is very large
  2. Surgeon chooses not to close the wound primarily because of high risk of infection
212
Q

Type of healing seen following closure if wounds in which there is obvious gross contamination at the incisional site

A

Third (delayed primary) intention

213
Q

Consisting of the placement of sutures, allowing the wound to stay open for a few days, and the subsequent closure of sutures

A

Third intention

214
Q

Type of wound healing used following removal of ruptured appendix in which there is leakage of pus into the peritoneal cavity

A

Third intention

215
Q

T/F: delayed healing eventually achieve the same integrity and strength as wounds that heal normally

A

True

216
Q

Wound healing characterized by decreased wound-breaking strength compared to normal

A

Delayed healing

217
Q

Wound healing characterized by a constant and continual increase that reaches a plateau at some point postinjury

A

Normal healing

218
Q

Wound healing characterized by a failure to achieve mechanical strength equivalent to normally healed wounds

A

Impaired healing

219
Q

Accumulation of blood at fracture site containing devitalized soft tissue, dead bone and necrotic marrow

A

Initial stage of hematoma formation

220
Q

T/F: Superficial injury of the cartilage is fast to heal.

A

False

221
Q

T/F: Hypovascular tendons tend to heal with less motion and more scar formation than tendons with better blood supply

A

True

222
Q

Types of nerve injuries and definition

A
  1. Neurapraxia - focal demyelination
  2. Axonotmesis - interruption of axonal continuity but preservation of Schwann cell basal lamina
  3. Neurotemesis - complete transection
223
Q

3 crucial steps in healing

A
  1. Survival of axonal bodies
  2. Regeneration of axons that grow across transected nerve to reach the distal stump
  3. Migration and connection of the regenerating nerve ends to the appropriate nerve ends or organ targets
224
Q

Phagocytic removal of degenerating axons and myelin sheath from distal stump

A

Wallerian degeneration

225
Q

Distinguishing feature of fetal wound healing

A

Lack of scar formation

226
Q

Effect of vitamin c deficiency in wound healing

A

Inadequate collagen production

227
Q

Effect of vitamin a deficiency in wound healing

A

Impaired fibroplasias, collagen synthesis, cross-linking and epithelialization

228
Q

Effect of vitamin b6 deficiency in wound healing

A

Impaired collagen cross-linking

229
Q

Effect of oxygenation in wound healing

A

Augment collagen synthesis

230
Q

Effect of corticosteroids in wound healin

A

Reduce wound inflammation, collagen synthesis and contraction

231
Q

Effect of diabetes mellitus in wound healing

A

Impair keratinocyte growth factor and platelet-derived growth factor functions in the wound

232
Q

T/F: degree of nutritional impairment need not be long standing in humans to affect wound healing

A

True

233
Q

T/F: supplemental vitamin a can reverse the inhibitory effects of corticosteroids on wound healing

A

True

234
Q

Most well-known element in wound healing

A

Zinc

235
Q

Effects of zinc deficiency in wound healing

A

Dec. fibroblast proliferation, dec. collagen synthesis, impaired overall wound strength, delayed epithelialization

236
Q

T/F: Immediate use of steroids postop does not affect wound healing severely

A

False

237
Q

Antibiotic prophylaxis is most effective when (2)

A
  1. Adequate concentrations of antibiotic are present in the tissues at the time of incision
  2. Adequate preoperative antibiotic dosing and timing
238
Q

Basis of selection of antibiotics for use in prophylaxis (3)

A
  1. Type of surgery to be performed
  2. Operative contaminants that might be encountered during the procedure
  3. The profile of resistant organisms present at the institution where the surgery is performed
239
Q

Most common organisms responsible for wound infection (in order of frequency)

A
  1. Staphylococcus species
  2. Coagulase-negative streptococcus
  3. Enterococci
  4. Escherichia coli
240
Q

Definition of wound infection (3)

A
  1. All wounds draining pus, whether or not the bacteriologic studies are positive
  2. Wounds that are opened by the surgeon
  3. Wounds that the surgeon considers infected
241
Q

Wound infection that involves skin and subcutaneous tissue only

A

Superficial incisional

242
Q

Wound infection that arise immediately adjacent to fascia, either above or below it, and may often have an intraabdominal component

A

Deep incisional

243
Q

Septic thrombosis of the vessels between the skin and the deep layers

A

Necrotizing fasciitis

244
Q

Most dangerous of the deep infections

A

Necrotizing fasciitis

245
Q

Differentiate contamination, colonization, infection

A

Contamination - presence of bacteria without multiplication
Colonization - multiplication without host response
Infection - presence of host response in reaction to deposition and multiplication of bacteria

246
Q

Genetically heterogeneous group of diseases in which the reduced NADPH-dependent oxide enzyme is deficient

A

Chronic granulomatous disease

247
Q

Used to diagnose CGD

A

Nitroblue tetrazolium reduction test

248
Q

Organisms most commonly responsible for CGD (5)

A 
S. Aureus
Aspergillus
Klebsiella
Serratia
Candida
249
Q

Factors affecting the level of vasoconstriction of the subcutaneous capillary bed

A

Fluid status, temperature, hyperactive sympathetic tone

250
Q

T/F: mild to moderate normovolemic anemia does not appear to adversely affect wound oxygen tension and collagen synthesis unless the hematocrit falls below 10%

A

False (15%)

251
Q

Major component of chronic wounds

A

Skin ulcers

252
Q

Malignant wounds are differentiated clinically from nonmalignant wounds by

A

Presence of overturned wound edges

253
Q

T/F: cancers arising de novo in chronic wounds include squamous cell carcinoma only

A

False (basal cell also)

254
Q

Ulcers that occur due to a lack of blood supply

A

Ischemic arterial ulcers

255
Q

Ischemic arterial ulcers are usually present at

A

Most distal portions of the extremities such as the interdigital clefts

256
Q

An ulcer that fails to re-epithelialize despite the presence of adequate granulation tissue

A

Venous stasis ulcer

257
Q

Commonly painless ulcer which results from incompetence of the deep venous system

A

Chronic venous ulcer

258
Q

Ulcer which is a site of incompetent perforators

A

Stasis ulcers

259
Q

Most common site of stasis ulcer

A

Above the medial malleolus, over Cockett’s perforator

260
Q

Treatment of venous ulcers

A

Compression therapy

261
Q

Major contributors of diabetic ulcers

A

Neuropathy (60-70%) secondary to persistently elevated glucose
Foot deformity
Ischemia (15-20%)

262
Q

Differentiate sensory neuropathy from motor neuropathy

A

Sensory - allows unrecognized injury to occur from ill-fitting shoes, foreign bodies, or other trauma
Motor (Charcot’s foot) - leads to collapse or dislocation of the interphalangeal or metatarsophalangeal joints, causing pressure on areas with little protection

263
Q

Localized area of tissue necrosis that develops when soft tissue is compressed between a bony prominence and an external surface

A

Decubitus or pressure ulcers

264
Q

Four stages of pressure ulcer formation

A

Stage I - nonblanching erythema of intact skin
Stage II - partial-thickness skin loss involving epidermis or dermis or both
Stage III - full-thickness skin loss, but not through the fascia
Stage IV - full-thickness skin loss with extensive involvement of muscle and bone

265
Q

Early surgical site infections that occur in the first 24 hours postop are most commonly due to

A

streptococcus or clostridium

266
Q

Infection of any anatomical structure remote from the incisional site but manipulated during the procedure

A

Organ/space surgical site infection

267
Q

Dose of contaminating microorganisms required to result in an increased risk of wound infection

A

10^5

268
Q

Poor operative techniques that may lead to wound failure

A

Suture material with inadequate tensile strength
Inadequate. Umber of sutures
Too small bite size

269
Q

Differentiate dehiscence and incisional hernia

A

Dehiscence - if wound failure occurs early in the postop course before all stages of wound healing have occurred
Incisional hernia - if months or years postop

270
Q

Hypertrophic scars vs keloids

A

Hypertrophic scar - subside spontaneously, in areas under tension, formed along the incisional line

Keloids - spread beyond the margins of original wound and are painful, require treatment, around earlobes and the deltoid, presternal and upper back regions

271
Q

Similarities of hypertrophic scars and keloids

A

Both occur after trauma to the skin and may be tender, pruritic and cause a burning sensation
Histologically - demonstrate increased thickness of the epidermis with absence of rete ridges, abundance of collagen and glycoprotein deposition

272
Q

Basics of wound management

A 
Optimize systemic parameters
Debride nonviable tissue
Reduce wound bioburden
Optimize blood flow
Reduce edema
Use dressings appropriately
Use pharmacologic therapy
Close wounds with grafts/flaps as indicated
273
Q

Removes pericellular transudate and wound exudate as well as deleterious enzymes

A

Negative pressure wound therapy

274
Q

Absorption characteristics of dressings

A

None - films
Low - hydrogels
Moderate - hydrocolloids
Hig - foams, alginates, collagen

275
Q

T/F: vitamin a have absolutely helps in normally healing wounds

A

False

276
Q

T/F: negative pressure wound therapy cannot be used in ischemic, badly infected or inadequately debrided wounds or in malignancy

A

True

277
Q

Guidelines for wound dressing

A

If nondraining - semi-occlusive dressing
If drainage (<1-2 ml/d) - semi-occlusive or absorbent nonadherent dressing
If moderately draining (3-5 ml/d) - nonadherent primary layer plus as absorbent secondary layer plus an occlusive dressing to protect normal tissue
If heavily draining (>5 ml/d) - same as above with the addition of a highly absorbent secondary layer

278
Q

T/F: epinephrine can be used in wounds of the fingers, toes, ears, nose or penis due to risk of tissue necrosis secondary to terminal arteriole vasospasm

A

False

279
Q

Signs of infection to look for before administration of antibiotics

A

Erythema, cellulitis, swelling, purulent discharge

280
Q

T/F: Wound dressing is contraindicated in infected and/or highly exudative wounds since it may enhance bacterial growth

A

True

281
Q

Tyoe of dressing designed to match the exudative properties of the wounds

A

Absorbent dressing

282
Q

T/F: Occlusive and semiocclusive dressings are water-proof and impermeable to microbes, water vapor and oxygen

A

False

Surgery I (3 decks)

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