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Anaesthetics, ED and Plastics > Wound Healing / Closure > Flashcards

Wound Healing / Closure Flashcards

1
Q

What are stages of wound healing

A

Haemostasis
Inflammation
Regeneration
Remodelling

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2
Q

Haemostasis phase

A

Vasoconstriction
Platelet plug
Generation of fibrin clot

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3
Q

Inflammation phase

A

Neutrophils migrate
Release of growth factor - VEGF
Fibroblasts migrate

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4
Q

Regeneration phase

A

Platelet derived growth factor stimulates fibroblasts
Collagen produced
Angiogenesis
Granulation tissue forms

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5
Q

Remodelling phase

A 
Longest phase
Fibroblast differentiate
Wound contracts
Collagen reomdells
Microvessels regress
Leaves pale scar
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6
Q

What impairs heeling

A 
Vascular disease
Shock
Sepsis 
Drugs 
Co-morbid - DM 
All impair microvascular flow
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7
Q

What drugs

A 
NSAID
Steroid
Immunosuppression
Anti-cancer
Ciprofloxacin
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8
Q

What are principles of wound management

A

1 - Inspection and exploration
2 - Wound irrigation e.g. 0.9% saline
3- Wound excision - any devitalised
4- Wound closure

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9
Q

If high degree of contamination / devitalised tissue what should you do

A

NEVER close during 1st management
Often return to operating theatre after 48 hours
Repeat steps 1-3
NEVER CLOSE A DIRTY WOUND

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10
Q

What do you use to clean wound

A

Sterile saline up to 48 hours

Shower after 48 hours

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11
Q

What are methods of wound closure

A 
Primary = most common 
Delayed primary 
Skin graft
Local flap
Distant flap 
Secondary intention
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12
Q

What is primary closure

A

Steristrip - not a lot of strength if mobile area
Suture - requires LA and removal
Stables

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13
Q

When is it used

A

Clean wounds

No significant tissue loss

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14
Q

What is delayed primary

A

Close within 24 hours before granulation occurs

Use if area is swollen

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15
Q

What type of graft

A

Split thickness

Full thickness

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16
Q

What is split thickness graft

A

Consist of epidermis
Various amounts of dermis
Use of mesh means large areas covered

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17
Q

How does the donor site heal

A

Granulation

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18
Q

Issues

A

Contract more than full thickness

Poor colour match

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19
Q

What is a full thickness graft

A

Entire dermis and epidermis

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20
Q

How does donor site heal

A

Requires closure

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21
Q

Issues

A

Only limited size can be used

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22
Q

What is a flap

A

Block of tissue with own blood supply

Used to reconstruct defects with insufficient blood or tissue characteristic needed

23
Q

Types of flap

A 
Skin
Muscle 
Myocutaneous
Fascial
Fascialcutaneous
24
Q

What is a distant flap

A

Transferred from remote location

25
Q

What is secondary intention

A

If not brought together by primary wound will heal but takes longer and leaves a scar

26
Q

When is it used

A

Dirty wound

Tissue loss where closure will result in infection and breakdown

27
Q

What is required

A

Time

Dressing changes

28
Q

What happens if wound dehiscence occurs

A

Senior help urgent
Sepsis 6
If superficial = pack
If deep = surgery

29
Q

How does skin graft work

A

Graft must attach to recipient site and gain a blood supply

30
Q

When can they not be used

A

Bone, tendon or cartilage stripped of outer covered
Exposed metalwork
Open joint
Cross-infectio

31
Q

What readily accepts a graft

A

Muscle

Fascia

32
Q

What is unsuitable

A

Fat

33
Q

What are abnormal scars

A

Hypertrophic

Keloid

34
Q

What is a hypertrophic scar

A

Raised above normal level due to excess collagen
Within boundaries
Often red and nodular

35
Q

What does it occur with

A

Full thickness

36
Q

What happens over time

A

Resolves

Contractuerss

37
Q

How do you help

A

Massaging

Sustained pressure

38
Q

What are keloid scars

A

Extend outwit boundaries of original scar
Occur within 3-4 week
Pink or red plaque with no nodules
Can become very large

39
Q

How do you Rx

A

Steroid injection
Sustained pressure
Excision + RT = last ditch

40
Q

What is process of suturing

A

Anaesthetise
Cleans wound
Suture
Dressing

41
Q

What do you use for anaesthetic

A

Lidocaine 3mg without adrenaline or 7mg / kg with adrenaline

42
Q

What do you do after administer

A

Check pin-prick
Assess depth and damage
Remove foreign body and debride prior to closure

43
Q

What do you discharge with

A

Advise on wound management / dressing
S+S of wound problems
Follow up advise

44
Q

What are special wounds

A

Lips
Face
Pre-tibial laceration
Knuckle ‘fight bite’

45
Q

Lips and face

A

Cosmesis

Requires careful suturing

46
Q

When is pre-tibial laceration common

A

Elderly as thin and fragile skin

47
Q

What is is issue

A

Suture won’t hold

48
Q

How do you Rx

A

Remove haematoma
Replace flap but do not cause tension so may not close
Steristrip and dres
Advise to rest and elevate leg

49
Q

What are issues with knuckle injury

A

Prone to infection
FB common
Always X-ray as risk of fracture to metacarpal

50
Q

How do you Rx

A

Hep B cover
Ax cover
2 closure if signs of infection

51
Q

What are types of gangrene

A

Wet
Dry
Gas

52
Q

Dry

A

Due to lack of blood supply

53
Q

Wet

A

If bacteria invades

54
Q

Gas

A

Gas forming organism

Anaesthetics, ED and Plastics (14 decks)

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