Wound Healing / Closure Flashcards
What are stages of wound healing
Haemostasis
Inflammation
Regeneration
Remodelling
Haemostasis phase
Vasoconstriction
Platelet plug
Generation of fibrin clot
Inflammation phase
Neutrophils migrate
Release of growth factor - VEGF
Fibroblasts migrate
Regeneration phase
Platelet derived growth factor stimulates fibroblasts
Collagen produced
Angiogenesis
Granulation tissue forms
Remodelling phase
Longest phase Fibroblast differentiate Wound contracts Collagen reomdells Microvessels regress Leaves pale scar
What impairs heeling
Vascular disease Shock Sepsis Drugs Co-morbid - DM All impair microvascular flow
What drugs
NSAID Steroid Immunosuppression Anti-cancer Ciprofloxacin
What are principles of wound management
1 - Inspection and exploration
2 - Wound irrigation e.g. 0.9% saline
3- Wound excision - any devitalised
4- Wound closure
If high degree of contamination / devitalised tissue what should you do
NEVER close during 1st management
Often return to operating theatre after 48 hours
Repeat steps 1-3
NEVER CLOSE A DIRTY WOUND
What do you use to clean wound
Sterile saline up to 48 hours
Shower after 48 hours
What are methods of wound closure
Primary = most common Delayed primary Skin graft Local flap Distant flap Secondary intention
What is primary closure
Steristrip - not a lot of strength if mobile area
Suture - requires LA and removal
Stables
When is it used
Clean wounds
No significant tissue loss
What is delayed primary
Close within 24 hours before granulation occurs
Use if area is swollen
What type of graft
Split thickness
Full thickness
What is split thickness graft
Consist of epidermis
Various amounts of dermis
Use of mesh means large areas covered
How does the donor site heal
Granulation
Issues
Contract more than full thickness
Poor colour match
What is a full thickness graft
Entire dermis and epidermis
How does donor site heal
Requires closure
Issues
Only limited size can be used
What is a flap
Block of tissue with own blood supply
Used to reconstruct defects with insufficient blood or tissue characteristic needed
Types of flap
Skin Muscle Myocutaneous Fascial Fascialcutaneous
What is a distant flap
Transferred from remote location
What is secondary intention
If not brought together by primary wound will heal but takes longer and leaves a scar
When is it used
Dirty wound
Tissue loss where closure will result in infection and breakdown
What is required
Time
Dressing changes
What happens if wound dehiscence occurs
Senior help urgent
Sepsis 6
If superficial = pack
If deep = surgery
How does skin graft work
Graft must attach to recipient site and gain a blood supply
When can they not be used
Bone, tendon or cartilage stripped of outer covered
Exposed metalwork
Open joint
Cross-infectio
What readily accepts a graft
Muscle
Fascia
What is unsuitable
Fat
What are abnormal scars
Hypertrophic
Keloid
What is a hypertrophic scar
Raised above normal level due to excess collagen
Within boundaries
Often red and nodular
What does it occur with
Full thickness
What happens over time
Resolves
Contractuerss
How do you help
Massaging
Sustained pressure
What are keloid scars
Extend outwit boundaries of original scar
Occur within 3-4 week
Pink or red plaque with no nodules
Can become very large
How do you Rx
Steroid injection
Sustained pressure
Excision + RT = last ditch
What is process of suturing
Anaesthetise
Cleans wound
Suture
Dressing
What do you use for anaesthetic
Lidocaine 3mg without adrenaline or 7mg / kg with adrenaline
What do you do after administer
Check pin-prick
Assess depth and damage
Remove foreign body and debride prior to closure
What do you discharge with
Advise on wound management / dressing
S+S of wound problems
Follow up advise
What are special wounds
Lips
Face
Pre-tibial laceration
Knuckle ‘fight bite’
Lips and face
Cosmesis
Requires careful suturing
When is pre-tibial laceration common
Elderly as thin and fragile skin
What is is issue
Suture won’t hold
How do you Rx
Remove haematoma
Replace flap but do not cause tension so may not close
Steristrip and dres
Advise to rest and elevate leg
What are issues with knuckle injury
Prone to infection
FB common
Always X-ray as risk of fracture to metacarpal
How do you Rx
Hep B cover
Ax cover
2 closure if signs of infection
What are types of gangrene
Wet
Dry
Gas
Dry
Due to lack of blood supply
Wet
If bacteria invades
Gas
Gas forming organism
